Treatments

TOPS™ Motion Preservation Spine Surgery
in Jupiter and Palm Beach

Minimally Invasive Spine Surgery (MISS) in Palm Beach County represents a significant advancement in treating spinal disorders with minimal disruption to surrounding tissues and faster recovery times.

If you have been told you may need lumbar spine surgery, one of the first questions that usually comes up is whether the spine has to be fused. For some patients, the answer may be no.

The TOPS™ System is a motion-preserving surgical option designed for certain people with lumbar spinal stenosis and Grade I degenerative spondylolisthesis at one level in the lower back. Rather than rigidly fusing that segment, the goal is to provide stability after decompression while still allowing controlled motion at the treated level. The device is FDA-approved for select adults with one-level disease from L3 to L5.

At Cuéllar Spine, Dr. Jason M. Cuéllar takes a thoughtful, diagnosis-driven approach to motion preservation. He is a board-certified, fellowship-trained orthopaedic spine surgeon serving patients in Jupiter, Palm Beach, Palm Beach Gardens, Boca Raton, and surrounding South Florida communities, with a practice that emphasizes both advanced surgical care and appropriate non-operative treatment when possible.

What is TOPS™ Motion Preservation Spine Surgery?

The TOPS™ System is a motion-preserving implant used in the lumbar spine after decompression surgery for select cases of spinal stenosis with degenerative spondylolisthesis. It is intended to support the treated segment without rigidly locking it the way a traditional fusion does. FDA materials describe it as a device used after decompression to stabilize the spine while preserving motion in carefully selected patients.

In simple terms, the goal is this: remove pressure from the nerves, then support the area in a way that may preserve movement rather than eliminating it completely.

That distinction matters to many patients. Some are active adults who want to understand every appropriate option before committing to fusion. Others simply want a more precise answer about what is actually causing their pain, numbness, weakness, or reduced walking tolerance.

Who May be a Candidate for the TOPS™ System?

TOPS™ is not a general treatment for all lower back pain. It is intended for a specific patient profile.

According to the FDA approval summary, the device is indicated for certain adults between 35 and 80 years old who have:

symptomatic degenerative spondylolisthesis up to Grade I
moderate to severe lumbar spinal stenosis
disease at one level from L3 to L5
associated thickening of the ligamentum flavum and/or scarring of the facet joint capsule
symptoms significant enough to warrant surgical treatment after appropriate evaluation

A patient may be considered for TOPS™ if they have:

persistent lower back pain with leg symptoms
nerve compression that affects standing or walking
imaging that matches their symptoms
failure of reasonable conservative treatment
anatomy that makes a motion-preserving option worth considering

The key word is may. Some patients are better served by other surgeries. Others may not need surgery at all. The right operation depends on the diagnosis, the stability of the spine, the severity of nerve compression, the patient’s goals, and the findings on imaging.

Conditions That May Lead to a TOPS™ Evaluation

Patients searching for this procedure often have already heard terms like spinal stenosis or spondylolisthesis, but may not know what those diagnoses actually mean.

A TOPS™ evaluation may be considered when symptoms relate to:

lumbar spinal stenosis
Grade I degenerative spondylolisthesis
nerve compression in the lower back
back pain that worsens with standing or walking
leg pain, numbness, heaviness, or weakness associated with stenosis

These symptoms can interfere with everyday life in ways that gradually become hard to ignore. Some people stop walking as far as they used to. Others find it harder to stand through work, travel comfortably, or stay active with family. When that happens, it makes sense to get a precise evaluation rather than keep guessing.

TOPS™ vs. Spinal Fusion

This is often the most important section for patients, because it gets to the heart of what makes this procedure different.

Spinal fusion is designed to stabilize a painful or unstable spinal segment by eliminating motion at that level. In many situations, fusion is still the right operation and remains an important part of spine surgery.

TOPS™, on the other hand, was developed as a motion-preserving alternative for select lumbar cases after decompression. Instead of rigid fixation, the goal is to maintain controlled movement at the treated level while still providing support. The TOPS™ System was approved by the FDA as the first device of its kind for this indication.

Motion Preservation May Appeal to Patients Who:

want to explore an alternative to fusion
are candidates for decompression plus stabilization at one lumbar level
value the possibility of preserving motion when appropriate
want a surgeon who can explain both options honestly

That said, motion preservation is not automatically “better.” The better procedure is the one that best fits the patient’s anatomy, diagnosis, symptoms, and long-term goals.

That is why Dr. Cuéllar’s evaluation is centered on judgment, not a one-procedure-fits-all mindset.

Potential Benefits of TOPS™ Motion Preservation Surgery

For the right candidate, a TOPS™ procedure may offer several potential advantages.

These may include:

preserving motion at the treated level rather than rigidly fusing it
stabilizing the spine after decompression in select cases
addressing symptoms related to lumbar stenosis and Grade I spondylolisthesis
offering a non-fusion option for appropriately selected patients
expanding treatment choices for people who want a motion-preserving discussion

The emphasis here should always be on appropriate selection. No spine implant should be presented as a universal answer. The value of TOPS™ lies in the fact that it creates another legitimate option for a specific group of patients who might otherwise assume fusion is their only surgical path.

When to Consider a Surgical Evaluation

Not everyone with back pain needs surgery, and not everyone with imaging findings needs a procedure. But there are times when it is reasonable to move from conservative care into a more advanced discussion.

You may want to schedule an evaluation if:

pain has not improved with time, medication, physical therapy, or injections
leg symptoms are limiting your walking or daily function
numbness or weakness is becoming more concerning
your MRI or X-rays show stenosis with instability or slippage
you have been told you may need fusion and want to understand whether motion preservation is an option

For many patients, the biggest relief comes from finally understanding what is actually happening in their spine. Even if TOPS™ is not the right answer, a high-quality evaluation can help clarify what is.

What to Expect During Your Consultation with Dr. Jason M. Cuéllar

At Cuéllar Spine, the process begins with a careful review of the full picture, not just one MRI image or one symptom.

Your evaluation may include:

a detailed discussion of your symptoms and how they affect daily life
review of prior treatments and response to care
physical examination
analysis of MRI, X-rays, and other imaging
discussion of both non-surgical and surgical options
an honest recommendation tailored to your diagnosis

Dr. Cuéllar’s practice highlights motion-preserving procedures such as artificial disc replacement, along with advanced minimally invasive and non-operative treatments. His site also emphasizes individualized spinal care across Palm Beach County and South Florida.

That matters, because patients considering TOPS™ are often not just looking for a surgeon. They are looking for judgment, experience, and a clear explanation of whether a motion-preserving strategy actually fits their case. Learn more about Dr. Cuéllar’s approach with TOPS™ Motion Preservation Spine Surgery here.

Why Choose Dr. Jason M. Cuéllar for a TOPS™ Consultation?

Choosing a spine surgeon for a motion-preserving discussion is not just about finding someone who performs procedures. It is about finding someone who understands when a motion-preserving option is appropriate, when it is not, and how to guide that decision responsibly.

Dr. Jason M. Cuéllar is:

a board-certified orthopaedic spine surgeon
fellowship-trained
focused on both surgical and non-surgical treatment
known for motion-preserving procedures
committed to individualized care for spinal disorders

That kind of balanced approach is especially important with a procedure like TOPS™. The best outcomes begin with selecting the right patient, the right indication, and the right operation.

Frequently Asked Questions About TOPS™ Spine Surgery

Is TOPS™ an alternative to spinal fusion?

For certain patients, yes. The TOPS™ System is intended as a motion-preserving alternative to fusion in select one-level lumbar cases involving Grade I degenerative spondylolisthesis and moderate to severe stenosis after decompression.

Is TOPS™ used for all kinds of back pain?

No. TOPS™ is not a general treatment for every form of back pain. It is indicated for a specific set of lumbar spine conditions and requires careful patient selection.

What part of the spine is TOPS™ used in?

The FDA approval applies to one level from L3 to L5 in the lumbar spine for qualified patients.

How do I know whether I need TOPS™ or fusion?

That depends on your diagnosis, imaging, spinal stability, symptoms, prior treatment, and surgical goals. The best way to know is through a thorough spine evaluation with a surgeon who can explain both options.

Do I need a consultation even if another doctor already recommended fusion?

Yes. If you have been told you may need fusion, it is reasonable to ask whether a motion-preserving option is worth considering in your case. Sometimes the original recommendation is exactly right. Sometimes another approach may be discussed. What matters is getting a diagnosis-driven answer.

Schedule a TOPS™ Motion Preservation Spine Consultation in Jupiter or Palm Beach

If you have been diagnosed with lumbar spinal stenosis or degenerative spondylolisthesis, and you want to know whether a motion-preserving alternative to fusion may be appropriate, a consultation is the next step.

At Cuéllar Spine, the goal is not to push one procedure. The goal is to identify the treatment that best matches your spine, your symptoms, and your goals.

Patients from Jupiter, Palm Beach, Palm Beach Gardens, and surrounding South Florida areas can request a consultation with Dr. Jason M. Cuéllar to learn whether TOPS™ motion preservation spine surgery, fusion, or another treatment path makes the most sense.