Northwell’s Staten Island University Hospital (SIUH) has become the first hospital on Staten Island to perform the Total Posterior Spine System (TOPS) procedure, a new surgical approach that offers an alternative to spinal fusion for patients with lumbar spinal stenosis and instability.
The surgery was led by Dr. Ronit Gilad, chair of neurosurgery at SIUH. Dr. Gilad explained, “Traditionally, patients like this would undergo a spinal fusion, which often limits mobility. With the TOPS procedure, we’re able to decompress the nerves while preserving movement — an important benefit for younger, active patients.”
One patient who received the procedure is Teresa Carrescia, a 47-year-old Staten Island resident who experienced severe back pain due to spinal stenosis, sciatica, and bulging discs. She had tried physical therapy and pain management injections for over a year without relief and was often bedridden. On her experience with the surgery, Carrescia said, “Right after the procedure, I could feel my legs and feet again. The pain that shot up and down my body was gone.” She also commended Dr. Gilad and the surgical team: “Everyone who touched my care was phenomenal. They checked on me constantly, explained everything, and made me feel safe.”
The TOPS system replaces damaged parts of the spine but allows natural movement in all directions—flexion, extension, lateral bending, and rotation—unlike traditional fusion procedures that restrict motion. It also aims to lower the risk of adjacent segment disease, which can occur after fusion surgeries.
The FDA approved TOPS in 2023; however, it remains limited in availability because of its recent approval and specific patient criteria. SIUH is among the first hospitals in the region—and one of only a few within Northwell Health—to offer this option. Only a small number of surgeons currently perform this procedure across Northwell Health facilities.
“This is an exciting new option for our patients,” said Dr. Gilad. “We’re happy to evaluate anyone who thinks they might qualify.”
