In applications like high-power LED lights, you'll often get 'Insulated Metal Substrate' PCBs where the printed circuit is on an aluminium or copper board, separated by a very thin electrically insulating layer. [1]
However, this has a few downsides: The electrically insulating layers aren't perfectly thermally conductive, meaning a directly attached heatsink will usually perform better; if you make a complex board with 8+ layers of copper (like a modern motherboard) you end up with 8+ layers of insulation; and it's nigh-impossible to use through-hole components.
For LED lighting those are non-issues and, a top-mounted heatsink wasn't an option anyway.
[1] https://dm.henkel-dam.com/is/content/henkel/Bergquist%20Comp...
I've been thinking about this for my ryzen lately too, since it appears keeping the top of the die cool is unusually challenging. A lot of mobile/etc parts use the PCB ground plane as a heatsink, so it makes sense that if you can attach a larger heatsink to the back of a normal PC board you should be able to pull heat out of both sides. Particularly in a water cooled system where the top of the heat spreader is remaining fairly cool but the surrounding board is heating up (like my ryzen).