Utilization of Total Posterior Spine System facet arthroplasty for management of adjacent segment disease following lumbar spinal fusion: illustrative case.

backgroundAdjacent segment disease (ASD) is a known complication of spinal fusion surgery, resulting from altered spinal biomechanics. The Total Posterior Spine (TOPS) facet replacement system has emerged as a motion-preserving alternative to lumbar fusion for patients with lumbar spinal stenosis and symptomatic degenerative spondylolisthesis. By maintaining segmental mobility, the TOPS System aims to reduce the incidence of ASD and improve postoperative function. OBSERVATIONS: A 43-year-old male with prior L4-5 discectomy, L4-5 transforaminal lumbar interbody fusion, and L5-S1 anterior lumbar interbody fusion developed progressive axial and radicular pain with lower limb paresthesia 12 months postoperatively. Imaging at 16 months revealed ASD at L3-4, demonstrating facet instability and stenosis. After multidisciplinary evaluation, the patient underwent TOPS facet arthroplasty, chosen over additional fusion given his surgical history and active lifestyle. Postoperatively, he experienced significant pain relief and full restoration of physical function. LESSONS: This case highlights ASD as a frequent complication of fusion procedures and illustrates the potential of motion-preserving technologies like the TOPS System to mitigate these effects. Further research is warranted to evaluate long-term outcomes and broader applicability of the TOPS System as a viable alternative to conventional spinal fusion. https://thejns.org/doi/10.3171/CASE25913.