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MAVERICK™ Total Disc Replacement- Pivotal Study

Primary Purpose

Spinal Diseases

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
MAVERICK™ Disc
LT-CAGE® Lumbar Tapered Fusion Device and INFUSE® Bone Graft
Sponsored by
Medtronic Spinal and Biologics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Diseases focused on measuring Lumbar degenerative disc disease at one level from L4-S1

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Has DDD as noted by back pain of discogenic origin, with or without leg pain, with degeneration of the disc confirmed by patient history
  • Has 1 or more of the following documented by CT, MRI, or plain x-rays: modic changes, high intensity zones in the annulus, loss of disc height, decreased hydration of the disc
  • Has documented annular pathology
  • Has single-level symptomatic degenerative involvement from L4-S1 requiring surgical treatment
  • Has intact facet joints at the involved vertebral levels documented by CT and/or MRI
  • Has preop Oswestry score≥30
  • Has preop back pain score ≥20
  • Age 18 to 70 yrs who are skeletally, mature, inclusive
  • Has not responded to non-operative treatment for 6 mos
  • If child-bearing potential, patient is non-pregnant, non-nursing, and agrees not to become pregnant for 1 yr after surgery
  • Is willing and able to comply with the study plan and sign the Patient Informed Consent Form

Exclusion Criteria:

  • Has primary diagnosis of a spinal disorder other than DDD at involved level
  • Had previous posterior lumbar spinal fusion surgical procedure at involved level
  • Had prior posterior lumbar surgery resulting in significant muscle/ligament morbidity, not including facet saving techniques
  • Had previous anterior lumbar spinal surgery at involved level
  • Requires spinal fusion and/or arthroplasty at more than 1 lumbar level
  • Has severe pathology of facet joints of involved vertebral bodies
  • Has any posterior element insufficiency
  • Has spondylolisthesis
  • Has spinal canal stenosis
  • Has rotatory scoliosis at involved level
  • Level treated has fractures secondary to trauma
  • Has any of the following that may be associated with a diagnosis of osteoporosis (if Yes, a DEXA Scan is required): Postmenopausal Non-Black female over 60 yrs of age and weighs less than 140 pounds; Postmenopausal female that has sustained a non-traumatic hip, spine or wrist fracture; Male over the age of 60 that has sustained a non-traumatic hip or spine fracture. If level of BMD is -3.5 or lower or -2.5 or lower with vertebral crush fracture, the patient is excluded
  • Has fever (temp > 101°F oral) at time of surgery
  • Has a condition that requires postop medications that interfere with fusion, such as steroids or prolonged use of non-steroidal anti-inflammatory drugs, excluding routine perioperative, non-steroidal anti-inflammatory drugs. Does not include low dose aspirin for prophylactic anticoagulation
  • Has overt or active bacterial infection, either local or systemic and/or potential for bacteremia
  • Has presence or prior history of malignancy (except for basal cell carcinoma of skin)
  • Has documented metal allergy, titanium alloy intolerance or cobalt-chrome-molybdenum alloy
  • Is mentally incompetent. If questionable, obtain psych consult
  • Has a Waddell Signs of Inorganic Behavior score of 3 or greater
  • Has chronic or acute renal and/or hepatic failure or prior history of renal and/or hepatic parenchymal disease
  • Is prisoner
  • Is pregnant
  • Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse
  • Has received drugs that may interfere with bone metabolism within 2 weeks prior to the surgery date, excluding routine perioperative, non-steroidal anti-inflammatory drugs
  • Has history of autoimmune disease
  • Has history of exposure to injectable collagen implants
  • Has history of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen
  • Has received treatment with an investigational therapy within 30 days prior to implantation surgery or treatment is planned during 24 months following the implantation surgery
  • Has received any previous exposure to any/all BMP's of either human or animal extraction
  • Has history of allergy to bovine products or a history of anaphylaxis
  • Has history of any endocrine or metabolic disorder known to affect osteogenesis
  • Has any disease that would preclude accurate clinical evaluation

Sites / Locations

  • The Spine Center at TOC
  • Spine Care Medical Group
  • Little Company of Mary Hospital
  • Newport Orthopedic Institute
  • Orthopaedic Specialty Institute
  • Boulder Neurosurgical Associates
  • Rocky Mountain Associates in Orthopaedic Medicine
  • Orthopaedic & Sports Medicine Center
  • First State Orthopaedics, P.A.
  • Walter Reed Army Medical Center
  • The B.A.C.K. Center
  • Hughston Clinic
  • Spine Institute of Idaho
  • Northwestern Orthopedic Institute
  • Illinois Bone and Joint Institute
  • Fort Wayne Orthopaedics
  • Orthopedics of Indianapolis
  • Institute for Low Back & Neck Care
  • Orthopedic Center of St. Louis
  • Nebraska Spine Center, LLC
  • New Hampshire Spine Institute
  • Hospital for Special Surgery
  • Spine Carolina
  • Oklahoma Sports Science & Ortho
  • Southeastern Spine Institute
  • Central Texas Spine
  • The Center for Spine Care
  • Advanced Neurosurgical Center
  • Virginia Spine Institute
  • Neurosurgical Associates, PC
  • Inland Neurosurgery and Spine Associates, PS
  • University of Wisconsin Orthopedic Department

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

MAVERICK™ Disc

Fusion

Arm Description

Outcomes

Primary Outcome Measures

Overall Success
A patient will be considered an overall success if all of the following conditions are met: pain/disability(Oswestry)success; neurological status success; disc height 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

Pain/Disability Status
The self-administered Oswestry Low Back pain Disability Questionnaire will be used. Success will be defined as pain/disability improvement postoperatively according to the following definition: Preoperative Score - Postoperative Score >= 15
Neurological Status
Neurological status will be evaluated preoperatively and postoperatively. Neurological status is based on four types of measurements (sections): motor, sensory, reflexes, and straight leg raise. Each of the categories is comprised of a number of elements. Postoperative evaluations on each element on the Neurological status case report form will be compared to the preoperative evaluations. Success will be defined as maintenance or improvement in each element for the time period evaluated.
Disc Height Measurement
Disc height will be measured postoperatively at each visit and compared to the measurement at 6 weeks postoperatively. Disc height success is based on either the anterior or posterior measurements meeting the following criterion: Postoperative Disc Height- 6 Week Postoperative Disc Height >= -2mm
General Health Status
The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) will be used to assess general health status. The SF-36 results can be summarized into two components, a physical component summary (PCS) and a mental component summary (MCS). Success will be defined as a maintenance or improvement in status postoperatively as compared to the preoperative condition. To be classified as a success, the following criteria must be met: PCSPostop - PCSPreop >= 0; MCSPostop - MCSPreop >= 0
Back Pain
Numerical rating scales will be used to evaluate pain intensity and duration. The pain score (0 min, 20 Max) is derived by adding the numerical rating scores from the pain intensity (0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be.") and duration scales (0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time"). Success for back and leg pain is described as follows: Preoperative Score - Postoperative Score >0
Leg Pain
Numerical rating scales will be used to evaluate pain intensity and duration. The pain score (0 min, 20 Max) is derived by adding the numerical rating scores from the pain intensity (0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be.") and duration scales (0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time"). Success for back and leg pain is described as follows: Preoperative Score - Postoperative Score >0
Patient Satisfaction
Patient Global Perceived Effect
Operative Time
Blood Loss
Number of Hospital Days

Full Information

First Posted
March 7, 2008
Last Updated
August 1, 2013
Sponsor
Medtronic Spinal and Biologics
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1. Study Identification

Unique Protocol Identification Number
NCT00635843
Brief Title
MAVERICK™ Total Disc Replacement- Pivotal Study
Official Title
"A Prospective, Randomized Controlled Clinical Investigation of MAVERICK™ Total Disc Replacement in Patients With Degenerative Disc Disease"
Study Type
Interventional

2. Study Status

Record Verification Date
October 2011
Overall Recruitment Status
Completed
Study Start Date
April 2003 (undefined)
Primary Completion Date
October 2006 (Actual)
Study Completion Date
November 2010 (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 clinical trial is to assess the safety and effectiveness of the MAVERICK™ Total Disc Replacement as a method of treating patients with lumbar degenerative disc disease at one level from L4-S1, with overall success being the primary endpoint of the clinical trial. The primary objective is to show non-inferiority of the investigational device to the control treatment. If non-inferiority is established, superiority will be examined.
Detailed Description
For this clinical trial, there are two treatment groups, i.e., investigational patients who receive the MAVERICK™ Total Disc Replacement and control patients who receive the anterior lumbar interbody fusion procedure with INFUSE® Bone Graft/LT-CAGE® Lumbar Tapered Fusion Device. Each investigational site will enroll patients in a 2:1 investigational:control treatment randomization scheme.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Diseases
Keywords
Lumbar degenerative disc disease at one level from L4-S1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
577 (Actual)

8. Arms, Groups, and Interventions

Arm Title
MAVERICK™ Disc
Arm Type
Experimental
Arm Title
Fusion
Arm Type
Active Comparator
Intervention Type
Device
Intervention Name(s)
MAVERICK™ Disc
Other Intervention Name(s)
MAVERICK™
Intervention Description
The MAVERICK™ disc is a spinal arthroplasty system and is intended to replace a damaged disc in the lumbar spine. It is a permanent implant used to maintain motion at the treated level and is inserted using an anterior surgical approach.
Intervention Type
Device
Intervention Name(s)
LT-CAGE® Lumbar Tapered Fusion Device and INFUSE® Bone Graft
Other Intervention Name(s)
Fusion
Intervention Description
The control is the treatment with LT-CAGE® Lumbar Tapered Fusion Device and INFUSE® Bone Graft. It is commercially available for anterior lumbar spine interbody fusion procedures.
Primary Outcome Measure Information:
Title
Overall Success
Description
A patient will be considered an overall success if all of the following conditions are met: pain/disability(Oswestry)success; neurological status success; disc height 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
Secondary Outcome Measure Information:
Title
Pain/Disability Status
Description
The self-administered Oswestry Low Back pain Disability Questionnaire will be used. Success will be defined as pain/disability improvement postoperatively according to the following definition: Preoperative Score - Postoperative Score >= 15
Time Frame
24 Months
Title
Neurological Status
Description
Neurological status will be evaluated preoperatively and postoperatively. Neurological status is based on four types of measurements (sections): motor, sensory, reflexes, and straight leg raise. Each of the categories is comprised of a number of elements. Postoperative evaluations on each element on the Neurological status case report form will be compared to the preoperative evaluations. Success will be defined as maintenance or improvement in each element for the time period evaluated.
Time Frame
24 months
Title
Disc Height Measurement
Description
Disc height will be measured postoperatively at each visit and compared to the measurement at 6 weeks postoperatively. Disc height success is based on either the anterior or posterior measurements meeting the following criterion: Postoperative Disc Height- 6 Week Postoperative Disc Height >= -2mm
Time Frame
24 months
Title
General Health Status
Description
The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) will be used to assess general health status. The SF-36 results can be summarized into two components, a physical component summary (PCS) and a mental component summary (MCS). Success will be defined as a maintenance or improvement in status postoperatively as compared to the preoperative condition. To be classified as a success, the following criteria must be met: PCSPostop - PCSPreop >= 0; MCSPostop - MCSPreop >= 0
Time Frame
24 months
Title
Back Pain
Description
Numerical rating scales will be used to evaluate pain intensity and duration. The pain score (0 min, 20 Max) is derived by adding the numerical rating scores from the pain intensity (0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be.") and duration scales (0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time"). Success for back and leg pain is described as follows: Preoperative Score - Postoperative Score >0
Time Frame
24 months
Title
Leg Pain
Description
Numerical rating scales will be used to evaluate pain intensity and duration. The pain score (0 min, 20 Max) is derived by adding the numerical rating scores from the pain intensity (0-10, with a score of 0 representing "no pain" and a score of 10 representing "pain as bad as it could be.") and duration scales (0-10, with a score of 0 being "pain none of the time" and a score of 10 being "pain all of the time"). Success for back and leg pain is described as follows: Preoperative Score - Postoperative Score >0
Time Frame
24 months
Title
Patient Satisfaction
Time Frame
24 months
Title
Patient Global Perceived Effect
Time Frame
24 months
Title
Operative Time
Time Frame
At the time of operation
Title
Blood Loss
Time Frame
At the time of operation
Title
Number of Hospital Days
Time Frame
At the time of discharge

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Has DDD as noted by back pain of discogenic origin, with or without leg pain, with degeneration of the disc confirmed by patient history Has 1 or more of the following documented by CT, MRI, or plain x-rays: modic changes, high intensity zones in the annulus, loss of disc height, decreased hydration of the disc Has documented annular pathology Has single-level symptomatic degenerative involvement from L4-S1 requiring surgical treatment Has intact facet joints at the involved vertebral levels documented by CT and/or MRI Has preop Oswestry score≥30 Has preop back pain score ≥20 Age 18 to 70 yrs who are skeletally, mature, inclusive Has not responded to non-operative treatment for 6 mos If child-bearing potential, patient is non-pregnant, non-nursing, and agrees not to become pregnant for 1 yr after surgery Is willing and able to comply with the study plan and sign the Patient Informed Consent Form Exclusion Criteria: Has primary diagnosis of a spinal disorder other than DDD at involved level Had previous posterior lumbar spinal fusion surgical procedure at involved level Had prior posterior lumbar surgery resulting in significant muscle/ligament morbidity, not including facet saving techniques Had previous anterior lumbar spinal surgery at involved level Requires spinal fusion and/or arthroplasty at more than 1 lumbar level Has severe pathology of facet joints of involved vertebral bodies Has any posterior element insufficiency Has spondylolisthesis Has spinal canal stenosis Has rotatory scoliosis at involved level Level treated has fractures secondary to trauma Has any of the following that may be associated with a diagnosis of osteoporosis (if Yes, a DEXA Scan is required): Postmenopausal Non-Black female over 60 yrs of age and weighs less than 140 pounds; Postmenopausal female that has sustained a non-traumatic hip, spine or wrist fracture; Male over the age of 60 that has sustained a non-traumatic hip or spine fracture. If level of BMD is -3.5 or lower or -2.5 or lower with vertebral crush fracture, the patient is excluded Has fever (temp > 101°F oral) at time of surgery Has a condition that requires postop medications that interfere with fusion, such as steroids or prolonged use of non-steroidal anti-inflammatory drugs, excluding routine perioperative, non-steroidal anti-inflammatory drugs. Does not include low dose aspirin for prophylactic anticoagulation Has overt or active bacterial infection, either local or systemic and/or potential for bacteremia Has presence or prior history of malignancy (except for basal cell carcinoma of skin) Has documented metal allergy, titanium alloy intolerance or cobalt-chrome-molybdenum alloy Is mentally incompetent. If questionable, obtain psych consult Has a Waddell Signs of Inorganic Behavior score of 3 or greater Has chronic or acute renal and/or hepatic failure or prior history of renal and/or hepatic parenchymal disease Is prisoner Is pregnant Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse Has received drugs that may interfere with bone metabolism within 2 weeks prior to the surgery date, excluding routine perioperative, non-steroidal anti-inflammatory drugs Has history of autoimmune disease Has history of exposure to injectable collagen implants Has history of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen Has received treatment with an investigational therapy within 30 days prior to implantation surgery or treatment is planned during 24 months following the implantation surgery Has received any previous exposure to any/all BMP's of either human or animal extraction Has history of allergy to bovine products or a history of anaphylaxis Has history of any endocrine or metabolic disorder known to affect osteogenesis Has any disease that would preclude accurate clinical evaluation
Facility Information:
Facility Name
The Spine Center at TOC
City
Huntsville
State/Province
Alabama
ZIP/Postal Code
35801
Country
United States
Facility Name
Spine Care Medical Group
City
Daly City
State/Province
California
ZIP/Postal Code
94015
Country
United States
Facility Name
Little Company of Mary Hospital
City
Los Angeles
State/Province
California
ZIP/Postal Code
90045
Country
United States
Facility Name
Newport Orthopedic Institute
City
Newport Beach
State/Province
California
ZIP/Postal Code
92660
Country
United States
Facility Name
Orthopaedic Specialty Institute
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Boulder Neurosurgical Associates
City
Boulder
State/Province
Colorado
ZIP/Postal Code
80304
Country
United States
Facility Name
Rocky Mountain Associates in Orthopaedic Medicine
City
Loveland
State/Province
Colorado
ZIP/Postal Code
80538
Country
United States
Facility Name
Orthopaedic & Sports Medicine Center
City
Trumbull
State/Province
Connecticut
ZIP/Postal Code
06611
Country
United States
Facility Name
First State Orthopaedics, P.A.
City
Newark
State/Province
Delaware
ZIP/Postal Code
19713
Country
United States
Facility Name
Walter Reed Army Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20307
Country
United States
Facility Name
The B.A.C.K. Center
City
Melbourne
State/Province
Florida
ZIP/Postal Code
32901-1937
Country
United States
Facility Name
Hughston Clinic
City
Columbus
State/Province
Georgia
ZIP/Postal Code
31908
Country
United States
Facility Name
Spine Institute of Idaho
City
Meridian
State/Province
Idaho
ZIP/Postal Code
83642
Country
United States
Facility Name
Northwestern Orthopedic Institute
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Illinois Bone and Joint Institute
City
Morton Grove
State/Province
Illinois
ZIP/Postal Code
60053
Country
United States
Facility Name
Fort Wayne Orthopaedics
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
46804
Country
United States
Facility Name
Orthopedics of Indianapolis
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46278
Country
United States
Facility Name
Institute for Low Back & Neck Care
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55407
Country
United States
Facility Name
Orthopedic Center of St. Louis
City
Chesterfield
State/Province
Missouri
ZIP/Postal Code
63017
Country
United States
Facility Name
Nebraska Spine Center, LLC
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68154-4428
Country
United States
Facility Name
New Hampshire Spine Institute
City
Bedford
State/Province
New Hampshire
ZIP/Postal Code
03110-4201
Country
United States
Facility Name
Hospital for Special Surgery
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Spine Carolina
City
Asheville
State/Province
North Carolina
ZIP/Postal Code
28803
Country
United States
Facility Name
Oklahoma Sports Science & Ortho
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73139
Country
United States
Facility Name
Southeastern Spine Institute
City
Mt. Pleasant
State/Province
South Carolina
ZIP/Postal Code
29464
Country
United States
Facility Name
Central Texas Spine
City
Austin
State/Province
Texas
ZIP/Postal Code
78731
Country
United States
Facility Name
The Center for Spine Care
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Advanced Neurosurgical Center
City
El Paso
State/Province
Texas
ZIP/Postal Code
79902
Country
United States
Facility Name
Virginia Spine Institute
City
Reston
State/Province
Virginia
ZIP/Postal Code
20190
Country
United States
Facility Name
Neurosurgical Associates, PC
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23229
Country
United States
Facility Name
Inland Neurosurgery and Spine Associates, PS
City
Spokane
State/Province
Washington
ZIP/Postal Code
99204
Country
United States
Facility Name
University of Wisconsin Orthopedic Department
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792-7375
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31100723
Citation
Gornet MF, Burkus JK, Dryer RF, Peloza JH, Schranck FW, Copay AG. Lumbar disc arthroplasty versus anterior lumbar interbody fusion: 5-year outcomes for patients in the Maverick disc investigational device exemption study. J Neurosurg Spine. 2019 May 17;31(3):347-356. doi: 10.3171/2019.2.SPINE181037.
Results Reference
derived
PubMed Identifier
23199378
Citation
Burkus JK, Dryer RF, Peloza JH. Retrograde ejaculation following single-level anterior lumbar surgery with or without recombinant human bone morphogenetic protein-2 in 5 randomized controlled trials: clinical article. J Neurosurg Spine. 2013 Feb;18(2):112-21. doi: 10.3171/2012.10.SPINE11908. Epub 2012 Nov 30.
Results Reference
derived

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MAVERICK™ Total Disc Replacement- Pivotal Study

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