TOPS Facet Replacement in NJ | Dr. Kris Radcliff

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TOPS Facet Replacement: An Alternative to Fusion

For many people with lumbar spinal stenosis and a slipped vertebra (degenerative spondylolisthesis), the traditional surgical answer has been a spinal fusion. The TOPS System is an FDA-approved alternative that relieves pressure on the nerves while keeping the spine moving. Dr. Kris Radcliff offers TOPS at Inspira Health and Hudson Regional Medical Center (now Secaucus University Hospital) and serves on the Data Safety Monitoring Board for the TOPS System.

What is the TOPS System?

TOPS stands for Total Posterior Spine System. After the surgeon removes the bone and thickened ligament pressing on the nerves, the TOPS implant replaces the worn facet joints at the back of the spine. It is attached with screws, but instead of locking the bones together like a fusion, it allows controlled bending, straightening and twisting.

FDA approval and research

The FDA approved the TOPS System in June 2023 after a randomized clinical trial that compared it with fusion (TLIF) in 168 patients at 37 sites. At two years, the TOPS group had a higher rate of overall clinical success than the fusion group, and the FDA label states that TOPS was superior to fusion on the trial’s main measure of success.

Who may be a candidate?

Adults age 35 to 80
Leg pain, numbness or difficulty walking from lumbar spinal stenosis
A mild (Grade I) slip of one vertebra at L3-L4 or L4-L5
Symptoms that have not improved with physical therapy, medications or injections

TOPS is not right for everyone. Patients with severe slippage, weak bones, problems at multiple levels or certain prior surgeries may be better served by another approach. Dr. Radcliff will review your MRI and X-rays, including standing and bending X-rays, to see whether you qualify.

What to expect

TOPS surgery is performed in the hospital and typically involves a short hospital stay. Most patients walk the same day or the next day, and many notice relief of leg pain early. Your recovery plan, activity limits and return to work will be tailored to you.

Where Dr. Radcliff performs TOPS

Hudson Regional Medical Center, now Secaucus University Hospital. A leader in robotic spine care in the New York metro area. Its spine surgeons were the first in the tri-state area to use the ExcelsiusGPS robotic system, its spine program earned accreditation from the Surgical Review Corporation as a Center of Excellence for spine surgery, and it was named a 2026 Castle Connolly Top Hospital in New Jersey for orthopedic and spine surgery.

Inspira Health (South Jersey). A nonprofit community health network with medical centers in Mullica Hill and Vineland, offering advanced surgical care close to home for patients in Gloucester, Cumberland, Salem and Atlantic counties. Inspira Medical Center Vineland has received the Women’s Choice Award for orthopedic care.

Told you need a fusion?

If you have been told you need a lumbar fusion for stenosis and spondylolisthesis, a second opinion can help you understand all of your options. Learn more about alternatives to fusion and spondylolisthesis.

Call 609-800-3472, book online, or send your MRI for a review.

Trial information is from the FDA approval and published reports. This page is general education and not medical advice. Disclosure: Dr. Radcliff serves on the Data Safety Monitoring Board for the TOPS System and has served as course faculty for Premia Spine.