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INFUSE® Bone Graft/ PEEK Interbody Spacer/ Anterior Cervical Plate Pivotal Clinical Trial (ACDF)

Primary Purpose

Degenerative Disc Disease

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
INFUSE® Bone Graft/PEEK Spacer/Anterior Cervical Plate
Sponsored by
Medtronic Spinal and Biologics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Degenerative Disc Disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • INCLUSION:

    1. Single-level cervical degenerative disc disease (from C3-C7) requiring surgical treatment and involving intractable radiculopathy and/or myelopathy.
    2. Herniated disc and/or osteophyte formation at the level to be treated that is producing symptomatic nerve root and/or spinal cord compression.
    3. Unresponsive to non-operative treatment for six weeks or has the presence of progressive symptoms or signs of nerve root/spinal cord compression in the face of continued non-operative management.
    4. At least 18 years of age and skeletally mature at the time of surgery.
    5. A preoperative Neck Disability Index (NDI) score ≥30.
    6. A preoperative neck pain score (pain intensity + pain frequency) ≥8 (out of 20) based on the preoperative Neck and Arm Pain Questionnaire.
    7. If a female of childbearing potential, patient is not pregnant or nursing and agrees not to become pregnant for one year following surgery.
    8. Is willing and able to comply with the study plan and able to understand and sign the Patient Informed Consent Form.

Exclusion Criteria:

  • EXCLUSION:

    1. A cervical spinal condition other than symptomatic cervical degenerative disc disease requiring surgical treatment at the involved level.
    2. Documented or diagnosed cervical instability at the target level, defined by dynamic (flexion/extension) radiographs.
    3. Previous surgical intervention at the involved level.
    4. Any subsequent planned/staged surgical procedure at the involved or adjacent level(s).
    5. Fused level adjacent to the level to be treated.
    6. Severe pathology of the facet joints of the involved vertebral bodies.
    7. Has osteoporosis, osteopenia, or osteomalacia as determined by DEXA scan.
    8. Presence of active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin).
    9. Overt or active bacterial infection, either local or systemic.
    10. Insulin dependent diabetes.
    11. Chronic or acute renal failure or prior history of renal disease.
    12. Documented allergy or intolerance to stainless steel, titanium, titanium alloy, polyetheretherketone (PEEK), or tantalum.
    13. Is mentally incompetent. (if questionable, obtain psychiatric consult.)
    14. Is a prisoner.
    15. Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse.
    16. On oral or injectable steroids for 6 weeks or more at the time of enrollment.
    17. A history of autoimmune disease.
    18. History of exposure to injectable collagen or silicone implants.
    19. History of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen.
    20. Received any previous exposure to any/all BMPs either human or animal extraction.
    21. History of allergy to bovine products.
    22. History of any allergy resulting in anaphylaxis.
    23. History of an endocrine or metabolic disorder known to affect osteogenesis (e.g., Paget's Disease, renal osteodystrophy, Ehlers-Danlos Syndrome, or osteogenesis imperfecta).
    24. Condition that requires postoperative medications that interfere with the stability of the implant, such as steroids.
    25. Received treatment with an investigational therapy (drug, device, or biologic) within 28 days prior to implantation surgery or such treatment is planned during the 24-month period following the study surgery.

Sites / Locations

  • S & B Surgery Center
  • Orange County Neurological Association
  • Crane Creek Medical Ctr. The Back Center /Osler Medical
  • The Hughston Clinic, P.C.
  • University of Kansas Medcal Center
  • Spine Institute
  • Springfield Neurological Institute
  • Buffalo Neurosurgery Group
  • University of Cincinnati Dept of Neurosurgery
  • TriState Orthopedic Treatment Center
  • The Washington Hospital
  • Center for Sports Medcine & Orthopedics
  • Semmes Murphey Neurologic & Spine Institute
  • Central Texas Spine
  • Brain and Spine Center of Texas, L.L.P.
  • Inland Neurosurgery & Spine Associates, P.S.

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

INFUSE® Bone Graft

Arm Description

In this arm, patients will receive implant with INFUSE® Bone Graft/PEEK Spacer/Anterior Cervical Plate.

Outcomes

Primary Outcome Measures

Rate of Overall Success
Rate of overall success is reported as the percentage of participants who met all of the following criteria: fusion at the treated level; pain/disability (Neck Disability Index) success; neurological status success; no serious adverse event classified as "implant associated" or "implant/surgical procedure associated;" no additional surgical procedure classified as a "failure."

Secondary Outcome Measures

Success Rate of Fusion
Success Rate of Fusion is reported as percent of participants who met the following fusion criteria: Evidence of bridging bone. This is based on the evidence of a continuous bony connection from the superior vertebral body to the inferior vertebral body in at least one of the following areas: lateral, anterior, posterior and/or through the PEEK spacer. No evidence of radiolucency at greater than 50% of the superior or inferior PEEK spacer-vertebra interface. No evidence of motion as defined by ≤ 4º of angular motion (based on flexion-extension lateral plain radiographs).
Success Rate of Neck Disability Index
Success rate of Neck Disability Index is reported as the percentage of participants whose neck disability index score met: Pre-treatment Score - Post-treatment Score ≥ 15.
Success Rate of Neurological Status
Success rate of neurological status is reported as the percentage of participants who met neurological success defined as maintenance or improvement in all sections (motor, sensory, and reflexes) for the time period evaluated. In order for a section to be considered a success, each element in the section must remain the same or improve from the time of the preoperative evaluation to the time period evaluated.
Neck Pain Success Rate
Neck pain success rate is reported as the percentage of participants whose neck pain improvement met: Preoperative Score - Postoperative Score > 0.
Arm Pain Success Rate
Arm pain success rate is reported as the percentage of participants whose arm pain improvement met: Preoperative Score - Postoperative Score > 0.
Success Rate of SF-36 PCS
Success rate of SF-36 Health Survey include two components: the success rate of a physical component summary (PCS) and the success rate of a mental component summary (MCS). The success rate of SF-36 PCS was defined as: Post Score - Pre Score >= 0.
Success Rate of SF-36 MCS
Success rate of SF-36 Health Survey include two components: the success rate of a physical component summary (PCS) and the success rate of a mental component summary (MCS). The success rates of SF-36 MCS were defined as: Post Score - Pre Score >= 0.
Operative Time
Operative time was recorded from skin incision to wound closure.
Blood Loss
Hospital Stay
Number of Patients Who Had Secondary Surgeries at the Index Level
Secondary surgical procedures at the index level included revisions, removal, supplemental fixation and reoperations.

Full Information

First Posted
June 8, 2007
Last Updated
February 14, 2013
Sponsor
Medtronic Spinal and Biologics
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1. Study Identification

Unique Protocol Identification Number
NCT00485173
Brief Title
INFUSE® Bone Graft/ PEEK Interbody Spacer/ Anterior Cervical Plate Pivotal Clinical Trial
Acronym
ACDF
Official Title
A Pivotal Clinical Investigation of INFUSE® Bone Graft With a PEEK Interbody Spacer and an Anterior Cervical Plate in Patients With Cervical Degenerative Disc Disease at a Single Level.
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
June 2007 (undefined)
Primary Completion Date
December 2011 (Actual)
Study Completion Date
June 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medtronic Spinal and Biologics

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the safety and effectiveness of the investigational implant (INFUSE® Bone Graft/PEEK Interbody Spacer/Anterior Cervical Plate) as a method of facilitating spinal fusion at a single level from C3-C7 in patients with symptomatic cervical degenerative disc disease.
Detailed Description
This pivotal clinical trial is being conducted to evaluate the safety and effectiveness of INFUSE® Bone Graft with the PEEK Interbody Spacer and Anterior Cervical Plate in patients with symptomatic cervical degenerative disc disease (DDD). The implant under investigation in this clinical trial is INFUSE® Bone Graft, the PEEK Interbody Spacer, and Anterior Cervical Plate. The device will be implanted using an anterior surgical approach. Safety and effectiveness data for patients in this study will be compared to that of historical controls. Historical control data will be taken from the control arms of the following Medtronic studies: (1) the Artificial Cervical Disc (also known as PRESTIGE® Cervical Disc System) pivotal IDE trial (NCT00642876) and (2) the BRYAN® Cervical Disc System pivotal IDE trial (NCT00437190).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Degenerative Disc Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
224 (Actual)

8. Arms, Groups, and Interventions

Arm Title
INFUSE® Bone Graft
Arm Type
Experimental
Arm Description
In this arm, patients will receive implant with INFUSE® Bone Graft/PEEK Spacer/Anterior Cervical Plate.
Intervention Type
Device
Intervention Name(s)
INFUSE® Bone Graft/PEEK Spacer/Anterior Cervical Plate
Other Intervention Name(s)
ACDF, Anterior Cervical Plate
Intervention Description
All patients enrolled in this study will receive the investigational device.
Primary Outcome Measure Information:
Title
Rate of Overall Success
Description
Rate of overall success is reported as the percentage of participants who met all of the following criteria: fusion at the treated level; pain/disability (Neck Disability Index) success; neurological status success; no serious adverse event classified as "implant associated" or "implant/surgical procedure associated;" no additional surgical procedure classified as a "failure."
Time Frame
24 months post-operation
Secondary Outcome Measure Information:
Title
Success Rate of Fusion
Description
Success Rate of Fusion is reported as percent of participants who met the following fusion criteria: Evidence of bridging bone. This is based on the evidence of a continuous bony connection from the superior vertebral body to the inferior vertebral body in at least one of the following areas: lateral, anterior, posterior and/or through the PEEK spacer. No evidence of radiolucency at greater than 50% of the superior or inferior PEEK spacer-vertebra interface. No evidence of motion as defined by ≤ 4º of angular motion (based on flexion-extension lateral plain radiographs).
Time Frame
24 months post-operation
Title
Success Rate of Neck Disability Index
Description
Success rate of Neck Disability Index is reported as the percentage of participants whose neck disability index score met: Pre-treatment Score - Post-treatment Score ≥ 15.
Time Frame
24 months post-operation
Title
Success Rate of Neurological Status
Description
Success rate of neurological status is reported as the percentage of participants who met neurological success defined as maintenance or improvement in all sections (motor, sensory, and reflexes) for the time period evaluated. In order for a section to be considered a success, each element in the section must remain the same or improve from the time of the preoperative evaluation to the time period evaluated.
Time Frame
24 months post-operation
Title
Neck Pain Success Rate
Description
Neck pain success rate is reported as the percentage of participants whose neck pain improvement met: Preoperative Score - Postoperative Score > 0.
Time Frame
24 months post-operation
Title
Arm Pain Success Rate
Description
Arm pain success rate is reported as the percentage of participants whose arm pain improvement met: Preoperative Score - Postoperative Score > 0.
Time Frame
24 months post-operation
Title
Success Rate of SF-36 PCS
Description
Success rate of SF-36 Health Survey include two components: the success rate of a physical component summary (PCS) and the success rate of a mental component summary (MCS). The success rate of SF-36 PCS was defined as: Post Score - Pre Score >= 0.
Time Frame
24 months post-operation
Title
Success Rate of SF-36 MCS
Description
Success rate of SF-36 Health Survey include two components: the success rate of a physical component summary (PCS) and the success rate of a mental component summary (MCS). The success rates of SF-36 MCS were defined as: Post Score - Pre Score >= 0.
Time Frame
24 months post-operation
Title
Operative Time
Description
Operative time was recorded from skin incision to wound closure.
Time Frame
Time of operation, approximately 1.5 hrs.
Title
Blood Loss
Time Frame
During the time of operation, approximately 1.5 hours.
Title
Hospital Stay
Time Frame
During the time of hospital stay, average of 1 day.
Title
Number of Patients Who Had Secondary Surgeries at the Index Level
Description
Secondary surgical procedures at the index level included revisions, removal, supplemental fixation and reoperations.
Time Frame
24 months post-operation
Other Pre-specified Outcome Measures:
Title
Neck Disability Index Score
Description
The self-administered Neck Disability Index (NDI) Questionnaire was used to assess patient neck pain and ability to function. The NDI scale ranges from 0-100. The best score is 0 (no disability) and worst is 100 (maximum disability).
Time Frame
24 months post-operation
Title
Neck Pain Score
Description
Numerical rating scales are used to evaluate neck pain intensity and frequency. Patients rate their neck pain intensity on a scale from 0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be." Similarly, patients record their neck pain frequency on a scale from 0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time." The total neck pain score is the sum of pain intensity and frequency scores.
Time Frame
24 months post-operation
Title
Arm Pain Score
Description
Numerical rating scales are used to evaluate arm pain intensity and frequency. Patients rate their arm pain intensity on a scale from 0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be." Similarly, patients record their arm pain frequency on a scale from 0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time." The total arm pain score will be the sum of pain intensity and frequency scores.
Time Frame
24 months post-operation
Title
General Health Status -- SF-36 PCS
Description
The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess general health status. The SF-36 results are summarized into two components, a physical component summary (PCS) and a mental component summary (MCS). The score for PCS is between 0 and 100, with higher scores denoting better quality of life.
Time Frame
24 months post-operation
Title
General Health Status -- SF-36 MCS
Description
The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess general health status. The SF-36 results are summarized into two components, a physical component summary (PCS) and a mental component summary (MCS). The score for MCS is between 0 and 100, with higher scores denoting better quality of life.
Time Frame
24 months post-operation
Title
Ossification in the Region of Target Level
Description
Ossification in the region of target level is reported as the percentage of the patients who had ossification in the region of the target level. The region of target level included the index level, the superior and inferior adjacent disc spaces, and the superior and inferior adjacent vertebral bodies.
Time Frame
24 months post-operation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: INCLUSION: Single-level cervical degenerative disc disease (from C3-C7) requiring surgical treatment and involving intractable radiculopathy and/or myelopathy. Herniated disc and/or osteophyte formation at the level to be treated that is producing symptomatic nerve root and/or spinal cord compression. Unresponsive to non-operative treatment for six weeks or has the presence of progressive symptoms or signs of nerve root/spinal cord compression in the face of continued non-operative management. At least 18 years of age and skeletally mature at the time of surgery. A preoperative Neck Disability Index (NDI) score ≥30. A preoperative neck pain score (pain intensity + pain frequency) ≥8 (out of 20) based on the preoperative Neck and Arm Pain Questionnaire. If a female of childbearing potential, patient is not pregnant or nursing and agrees not to become pregnant for one year following surgery. Is willing and able to comply with the study plan and able to understand and sign the Patient Informed Consent Form. Exclusion Criteria: EXCLUSION: A cervical spinal condition other than symptomatic cervical degenerative disc disease requiring surgical treatment at the involved level. Documented or diagnosed cervical instability at the target level, defined by dynamic (flexion/extension) radiographs. Previous surgical intervention at the involved level. Any subsequent planned/staged surgical procedure at the involved or adjacent level(s). Fused level adjacent to the level to be treated. Severe pathology of the facet joints of the involved vertebral bodies. Has osteoporosis, osteopenia, or osteomalacia as determined by DEXA scan. Presence of active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin). Overt or active bacterial infection, either local or systemic. Insulin dependent diabetes. Chronic or acute renal failure or prior history of renal disease. Documented allergy or intolerance to stainless steel, titanium, titanium alloy, polyetheretherketone (PEEK), or tantalum. Is mentally incompetent. (if questionable, obtain psychiatric consult.) Is a prisoner. Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse. On oral or injectable steroids for 6 weeks or more at the time of enrollment. A history of autoimmune disease. History of exposure to injectable collagen or silicone implants. History of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen. Received any previous exposure to any/all BMPs either human or animal extraction. History of allergy to bovine products. History of any allergy resulting in anaphylaxis. History of an endocrine or metabolic disorder known to affect osteogenesis (e.g., Paget's Disease, renal osteodystrophy, Ehlers-Danlos Syndrome, or osteogenesis imperfecta). Condition that requires postoperative medications that interfere with the stability of the implant, such as steroids. Received treatment with an investigational therapy (drug, device, or biologic) within 28 days prior to implantation surgery or such treatment is planned during the 24-month period following the study surgery.
Facility Information:
Facility Name
S & B Surgery Center
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90210
Country
United States
Facility Name
Orange County Neurological Association
City
Laguna Hills
State/Province
California
ZIP/Postal Code
92653
Country
United States
Facility Name
Crane Creek Medical Ctr. The Back Center /Osler Medical
City
Melbourne
State/Province
Florida
ZIP/Postal Code
32901
Country
United States
Facility Name
The Hughston Clinic, P.C.
City
Columbus
State/Province
Georgia
ZIP/Postal Code
31908
Country
United States
Facility Name
University of Kansas Medcal Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Spine Institute
City
Shreveport
State/Province
Louisiana
ZIP/Postal Code
71103
Country
United States
Facility Name
Springfield Neurological Institute
City
Springfield
State/Province
Missouri
ZIP/Postal Code
65804
Country
United States
Facility Name
Buffalo Neurosurgery Group
City
West Seneca
State/Province
New York
ZIP/Postal Code
14224
Country
United States
Facility Name
University of Cincinnati Dept of Neurosurgery
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45219
Country
United States
Facility Name
TriState Orthopedic Treatment Center
City
Norwood
State/Province
Ohio
ZIP/Postal Code
45212
Country
United States
Facility Name
The Washington Hospital
City
Washington
State/Province
Pennsylvania
ZIP/Postal Code
15301
Country
United States
Facility Name
Center for Sports Medcine & Orthopedics
City
Chattanooga
State/Province
Tennessee
ZIP/Postal Code
37404
Country
United States
Facility Name
Semmes Murphey Neurologic & Spine Institute
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38120
Country
United States
Facility Name
Central Texas Spine
City
Austin
State/Province
Texas
ZIP/Postal Code
78731
Country
United States
Facility Name
Brain and Spine Center of Texas, L.L.P.
City
Plano
State/Province
Texas
ZIP/Postal Code
75093
Country
United States
Facility Name
Inland Neurosurgery & Spine Associates, P.S.
City
Spokane
State/Province
Washington
ZIP/Postal Code
99204
Country
United States

12. IPD Sharing Statement

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INFUSE® Bone Graft/ PEEK Interbody Spacer/ Anterior Cervical Plate Pivotal Clinical Trial

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