Study to Investigate the Performance of Cervical Arthroplasty for the Treatment of Cervical Degenerative Disc Disease
Primary Purpose
Cervical Degenerative Disc Disease
Status
Terminated
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
DISCOVER™ Artificial Cervical Disc
ACDF
Sponsored by
About this trial
This is an interventional treatment trial for Cervical Degenerative Disc Disease focused on measuring Cervical, Disc, Arthroplasty, Spinal
Eligibility Criteria
Inclusion Criteria:
- Male or female subjects, aged between 18 and 65 years inclusive.
- Subjects who are able to give voluntary, written informed consent to participate in this clinical investigation and from whom consent has been obtained.
- Subjects who, in the opinion of the Clinical Investigator, are able to understand this clinical investigation, co-operate with the investigational procedures and are willing to return to the hospital for all the required post-operative follow-ups.
Objective evidence of cervical disc disease in one vertebral level between C3-C7 defined as one or more of the following:
- Shoulder and/or arm pain in a radicular distribution resulting from herniated disc or bony osteophytes (Consistent w diagnostic imaging including Axial CT, CT Myelogram, MRI and/or plain films)
- Subjects with myeloradiculopathy resulting from mild spinal cord compression and nerve root impingement
- Unresponsive to documented non-surgical management for ≥ 6 weeks and/or presents with progressive symptoms of nerve root or spinal cord compression in the face of continued non-surgical management (e.g., physical therapy, medication therapy, corticosteroid injections, etc.)
- Minimum Neck Disability Index score of ≥30 % (15/50 points)
Exclusion Criteria:
- Subjects who, in the opinion of the Clinical Investigator, have an existing condition that would compromise their participation and follow-up in this clinical investigation.
- Subjects who are pregnant, lactating or wishes to become pregnant within the duration of the study.
- Subjects who are known drug or alcohol abusers or with psychological disorders that could affect follow-up care or treatment outcomes.
- Subjects who have participated in a clinical investigation with an investigational product in the last 30 days.
- Subjects who are currently involved in any injury litigation claims.
- Subjects with significant degeneration at more than one cervical level (e.g. DISH, ankylosing spondylitis, congenital abnormality, rheumatoid arthritis)
- Subjects who have had any prior surgery at the level to be treated (subjects with a prior Laminotomy at the level to be treated may be included in the study)
- Subjects who have marked cervical instability on lateral or flexion/extension x-rays defined as translation ≥3mm and/or ≥11 degrees of rotational difference to either adjacent level
- Subjects who have presence of systemic infection or infection at the site of surgery
- Subjects who have been diagnosed with malignancy
- Subjects who have been diagnosed with a condition or require postoperative medication(s) that may interfere with bony/soft tissue healing
- Subjects who have been diagnosed with Osteoporosis, Osteopenia, other metabolic bone disease or endocrine disorder known to affect osteogenesis.
- Subjects with pre-existing neurological abnormalities other than deficits produced from the spinal lesion (e.g., MS, Parkinson's, CVA, diabetic neuropathy, peripheral neuropathy).
- Subjects with morbid obesity defined as a BMI of ≥40, or more than 100 lbs (45.4kg) over ideal weight.
- Subjects with any known allergy to titanium metal, polyethylene, metal alloy or carbon fibre reinforced polymer
- Subjects who have had prior fusion surgery at any level(s) (C1-T1)
- Subjects with kyphosis >-15 degrees evaluated using the Cobb angle measurement
- Subjects with Significant cervical degenerative disease characterized by bridging anterior osteophytes, significant loss of disc space height (3mm or less), sclerotic facets, large posterior osteophytes, autofusion of other cervical levels, and degenerative retrolisthesis. Spinal diseases such as DISH, ankylosing spondylitis, congenital abnormality, and rheumatoid arthritis, should also be excluded
- Subjects undergoing treatment with a bone growth stimulator, which cannot be discontinued prior to enrollment in the study.
- Significant kyphotic deformity or significant reversal of lordosis.
Sites / Locations
- Westmead Private Hospital
- Calvary Hospital
- Klinikum Neustadt
- Divisione di Neurochirurgia
- Island Hospital
- Elisabeth Ziekenhuis
- La Paz Hospital
- Hope Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Other
Active Comparator
Arm Label
Anterior Cervical Discectomy and Fusion (ACDF)
Cervical Total Disc Replacement
Arm Description
Anterior Cervical Discectomy and Fusion with Cervical CFRP I/F CAGE® and SLIM LOC(R) Anterior Cervical Plate System with allograft
DISCOVER™ Artificial Cervical Disc
Outcomes
Primary Outcome Measures
Overall Patient Success
Overall success was a composite endpoint determined by the following clinical outcome measures: 1. Neck Disability Index ≥ 15-point improvement from baseline to 12 months post-operative, 2. No new clinically significant permanent abnormalities in neurological function (i.e. motor strength, nerve root tension signs, sensory and reflex signs) from baseline to 12 months post-operative, 3. No subsequent secondary surgical interventions (SSI) at the index level, and 4. No device-related serious events (dSAE) from intra-operative through 12-months post-operative. Please note that these time periods were intended to be from baseline to 24 months post-operative, but since the study was terminated early the 12 month time periods were utilized.
Secondary Outcome Measures
Change in Visual Analogue Scale (VAS) Neck Pain From Pre-treatment to 12 Months
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their neck.
Change in Visual Analogue Scale (VAS) Left Arm Pain From Pre-treatment to 12 Months.
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their left arm.
Change in Visual Analogue Scale (VAS) Right Arm Pain From Pre-treatment to 12 Months.
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0= 0 cm) listed on the left and 'Very severe pain' (score of 100= 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their right arm.
Change in Visual Analogue Scale (VAS) Right Shoulder Pain From Pre-treatment to 12 Months.
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their right shoulder.
Change in Visual Analogue Scale (VAS) Left Shoulder Pain From Pre-treatment to 12 Months.
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 10 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their left shoulder.
Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 From Pre-treatment to 12 Months
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into 2 summary measures that are scored from 0 to 100 (where 100 indicates the highest level of health) - the Physical Component Score (PCS-36) and Mental Component Score (MCS-36)
Change in Physical Component Summary Quality of Life Measure Assessed by Short Form SF-36 From Pre-treatment to 12 Months
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into 2 summary measures that are scored from 0 to 100 (where 100 indicates the highest level of health) - the Physical Component Score (PCS-36) and Mental Component Score (MCS-36)
Change in Function Assessed by Neck Disability Index Improvement From Pre-treatment to 12 Months
The neck disability index (NDI) is a validated, disease specific, self-administrated questionnaire for assessing pain intensity and function in patients with neck pain on a scale from 0 to 100. A lower score is a better result (i.e. less severe pain and/or better function). The proportion of patients with an improved score (lower) of 15 points or more was the analysis variable.
Work Status Assessed at 12 Months
The proportion of subjects with unrestricted work status (compared to subjects not working or with restricted work status) is reported at the 12 month follow-up interval.
Sagittal Angulation, Also Known as Global Lordosis, Measured Radiographically at 6 Months
Sagittal Angulation is a measure of the angle formed between the inferior endplate of the C2 vertebrae and the corresponding inferior endplate of vertebrae C7 of the spine, measured in degrees, from a side (sagittal) view.
Adjacent Level Degeneration Measured Radiographically at 24 Months
Adjacent Level Degeneration is evaluated using a point system that assigns numerical scores to severity of Height Loss, Anterior Osteophytes, and Endplate Sclerosis; and then grades into one of the following five categories: None, Mild, Moderate, Severe, or NA.
Maintenance of Disc Height Measured Radiographically at 6 Months
Maintenance of disc height is measured at the index and adjacent levels to determine the effect of the treatment on restoration or maintenance of the disc height. Initial post-operative disc height is compared with subsequent post-operative visits (i.e. 6 months) to evaluate the maintenance of disc height. The height is measured in millimeters (mm).
Foraminal Height Measured Radiographically at 24 Months
Foraminal height is the maximum vertical distance, measured in millimeters (mm), between the inferior surface of the superior pedicle and superior surface of the inferior pedicle. These measurements are obtained via magnetic resonance imaging (MRI).
Cervical Range of Motion Measured Radiographically at 6 Months
Cervical range of motion measures the angle, in degrees, between the inferior endplate of C2 to the inferior endplate of C7 on flexion-extension radiographs.
Device Related Adverse Events
The proportion of subjects with device related adverse events as reported throughout the duration of the study.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT00700739
Brief Title
Study to Investigate the Performance of Cervical Arthroplasty for the Treatment of Cervical Degenerative Disc Disease
Official Title
A Multi-Centre, Prospective, Randomized, Post Marketing Surveillance Study Comparing Cervical Arthroplasty to Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Cervical Degenerative Disc Disease
Study Type
Interventional
2. Study Status
Record Verification Date
September 2015
Overall Recruitment Status
Terminated
Why Stopped
study progress and recruitment rate too low
Study Start Date
May 2008 (undefined)
Primary Completion Date
May 2010 (Actual)
Study Completion Date
May 2010 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
DePuy International
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of the study is to evaluate the performance of the Discover cervical Artificial disc in the treatment of degenerative disc disease in one level of the cervical spine.
Detailed Description
The protocol underwent 3 amendments, the last of which (02APR2009) changed the study design from a randomized to a non-randomized and non-comparative clinical trial. All of the subjects were enrolled under the randomized design with the exception of the last subject. This study is not applicable per FDAA Title VIII, Section 801 due to the final trial design. However, results are submitted to clinicaltrials.gov due to the majority of study data being collected under a randomized (FDAA Title VIII, Section 801 applicable) trial design
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cervical Degenerative Disc Disease
Keywords
Cervical, Disc, Arthroplasty, Spinal
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Anterior Cervical Discectomy and Fusion (ACDF)
Arm Type
Other
Arm Description
Anterior Cervical Discectomy and Fusion with Cervical CFRP I/F CAGE® and SLIM LOC(R) Anterior Cervical Plate System with allograft
Arm Title
Cervical Total Disc Replacement
Arm Type
Active Comparator
Arm Description
DISCOVER™ Artificial Cervical Disc
Intervention Type
Device
Intervention Name(s)
DISCOVER™ Artificial Cervical Disc
Intervention Description
DISCOVER™ Artificial Cervical Disc
Intervention Type
Device
Intervention Name(s)
ACDF
Intervention Description
Cervical CFRP I/F CAGE® and SLIM LOC(R) Anterior Cervical Plate System with allograft
Primary Outcome Measure Information:
Title
Overall Patient Success
Description
Overall success was a composite endpoint determined by the following clinical outcome measures: 1. Neck Disability Index ≥ 15-point improvement from baseline to 12 months post-operative, 2. No new clinically significant permanent abnormalities in neurological function (i.e. motor strength, nerve root tension signs, sensory and reflex signs) from baseline to 12 months post-operative, 3. No subsequent secondary surgical interventions (SSI) at the index level, and 4. No device-related serious events (dSAE) from intra-operative through 12-months post-operative. Please note that these time periods were intended to be from baseline to 24 months post-operative, but since the study was terminated early the 12 month time periods were utilized.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Change in Visual Analogue Scale (VAS) Neck Pain From Pre-treatment to 12 Months
Description
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their neck.
Time Frame
12 months
Title
Change in Visual Analogue Scale (VAS) Left Arm Pain From Pre-treatment to 12 Months.
Description
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their left arm.
Time Frame
12 Months
Title
Change in Visual Analogue Scale (VAS) Right Arm Pain From Pre-treatment to 12 Months.
Description
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0= 0 cm) listed on the left and 'Very severe pain' (score of 100= 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their right arm.
Time Frame
12 Months
Title
Change in Visual Analogue Scale (VAS) Right Shoulder Pain From Pre-treatment to 12 Months.
Description
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 100 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their right shoulder.
Time Frame
12 Months
Title
Change in Visual Analogue Scale (VAS) Left Shoulder Pain From Pre-treatment to 12 Months.
Description
The visual analogue scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line (that is approximately 10 cm long) with 'No Pain' (score of 0 = 0 cm) listed on the left and 'Very severe pain' (score of 10 = 10 cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their left shoulder.
Time Frame
12 Months
Title
Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 From Pre-treatment to 12 Months
Description
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into 2 summary measures that are scored from 0 to 100 (where 100 indicates the highest level of health) - the Physical Component Score (PCS-36) and Mental Component Score (MCS-36)
Time Frame
12 months
Title
Change in Physical Component Summary Quality of Life Measure Assessed by Short Form SF-36 From Pre-treatment to 12 Months
Description
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into 2 summary measures that are scored from 0 to 100 (where 100 indicates the highest level of health) - the Physical Component Score (PCS-36) and Mental Component Score (MCS-36)
Time Frame
12 months
Title
Change in Function Assessed by Neck Disability Index Improvement From Pre-treatment to 12 Months
Description
The neck disability index (NDI) is a validated, disease specific, self-administrated questionnaire for assessing pain intensity and function in patients with neck pain on a scale from 0 to 100. A lower score is a better result (i.e. less severe pain and/or better function). The proportion of patients with an improved score (lower) of 15 points or more was the analysis variable.
Time Frame
12 months
Title
Work Status Assessed at 12 Months
Description
The proportion of subjects with unrestricted work status (compared to subjects not working or with restricted work status) is reported at the 12 month follow-up interval.
Time Frame
12 months
Title
Sagittal Angulation, Also Known as Global Lordosis, Measured Radiographically at 6 Months
Description
Sagittal Angulation is a measure of the angle formed between the inferior endplate of the C2 vertebrae and the corresponding inferior endplate of vertebrae C7 of the spine, measured in degrees, from a side (sagittal) view.
Time Frame
6 months
Title
Adjacent Level Degeneration Measured Radiographically at 24 Months
Description
Adjacent Level Degeneration is evaluated using a point system that assigns numerical scores to severity of Height Loss, Anterior Osteophytes, and Endplate Sclerosis; and then grades into one of the following five categories: None, Mild, Moderate, Severe, or NA.
Time Frame
24 months
Title
Maintenance of Disc Height Measured Radiographically at 6 Months
Description
Maintenance of disc height is measured at the index and adjacent levels to determine the effect of the treatment on restoration or maintenance of the disc height. Initial post-operative disc height is compared with subsequent post-operative visits (i.e. 6 months) to evaluate the maintenance of disc height. The height is measured in millimeters (mm).
Time Frame
6 months
Title
Foraminal Height Measured Radiographically at 24 Months
Description
Foraminal height is the maximum vertical distance, measured in millimeters (mm), between the inferior surface of the superior pedicle and superior surface of the inferior pedicle. These measurements are obtained via magnetic resonance imaging (MRI).
Time Frame
24 months
Title
Cervical Range of Motion Measured Radiographically at 6 Months
Description
Cervical range of motion measures the angle, in degrees, between the inferior endplate of C2 to the inferior endplate of C7 on flexion-extension radiographs.
Time Frame
6 months
Title
Device Related Adverse Events
Description
The proportion of subjects with device related adverse events as reported throughout the duration of the study.
Time Frame
Intra-operatively to 24 months post-operative
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female subjects, aged between 18 and 65 years inclusive.
Subjects who are able to give voluntary, written informed consent to participate in this clinical investigation and from whom consent has been obtained.
Subjects who, in the opinion of the Clinical Investigator, are able to understand this clinical investigation, co-operate with the investigational procedures and are willing to return to the hospital for all the required post-operative follow-ups.
Objective evidence of cervical disc disease in one vertebral level between C3-C7 defined as one or more of the following:
Shoulder and/or arm pain in a radicular distribution resulting from herniated disc or bony osteophytes (Consistent w diagnostic imaging including Axial CT, CT Myelogram, MRI and/or plain films)
Subjects with myeloradiculopathy resulting from mild spinal cord compression and nerve root impingement
Unresponsive to documented non-surgical management for ≥ 6 weeks and/or presents with progressive symptoms of nerve root or spinal cord compression in the face of continued non-surgical management (e.g., physical therapy, medication therapy, corticosteroid injections, etc.)
Minimum Neck Disability Index score of ≥30 % (15/50 points)
Exclusion Criteria:
Subjects who, in the opinion of the Clinical Investigator, have an existing condition that would compromise their participation and follow-up in this clinical investigation.
Subjects who are pregnant, lactating or wishes to become pregnant within the duration of the study.
Subjects who are known drug or alcohol abusers or with psychological disorders that could affect follow-up care or treatment outcomes.
Subjects who have participated in a clinical investigation with an investigational product in the last 30 days.
Subjects who are currently involved in any injury litigation claims.
Subjects with significant degeneration at more than one cervical level (e.g. DISH, ankylosing spondylitis, congenital abnormality, rheumatoid arthritis)
Subjects who have had any prior surgery at the level to be treated (subjects with a prior Laminotomy at the level to be treated may be included in the study)
Subjects who have marked cervical instability on lateral or flexion/extension x-rays defined as translation ≥3mm and/or ≥11 degrees of rotational difference to either adjacent level
Subjects who have presence of systemic infection or infection at the site of surgery
Subjects who have been diagnosed with malignancy
Subjects who have been diagnosed with a condition or require postoperative medication(s) that may interfere with bony/soft tissue healing
Subjects who have been diagnosed with Osteoporosis, Osteopenia, other metabolic bone disease or endocrine disorder known to affect osteogenesis.
Subjects with pre-existing neurological abnormalities other than deficits produced from the spinal lesion (e.g., MS, Parkinson's, CVA, diabetic neuropathy, peripheral neuropathy).
Subjects with morbid obesity defined as a BMI of ≥40, or more than 100 lbs (45.4kg) over ideal weight.
Subjects with any known allergy to titanium metal, polyethylene, metal alloy or carbon fibre reinforced polymer
Subjects who have had prior fusion surgery at any level(s) (C1-T1)
Subjects with kyphosis >-15 degrees evaluated using the Cobb angle measurement
Subjects with Significant cervical degenerative disease characterized by bridging anterior osteophytes, significant loss of disc space height (3mm or less), sclerotic facets, large posterior osteophytes, autofusion of other cervical levels, and degenerative retrolisthesis. Spinal diseases such as DISH, ankylosing spondylitis, congenital abnormality, and rheumatoid arthritis, should also be excluded
Subjects undergoing treatment with a bone growth stimulator, which cannot be discontinued prior to enrollment in the study.
Significant kyphotic deformity or significant reversal of lordosis.
Facility Information:
Facility Name
Westmead Private Hospital
City
Sydney
State/Province
New South Wales
Country
Australia
Facility Name
Calvary Hospital
City
Tasmania
Country
Australia
Facility Name
Klinikum Neustadt
City
Neustadt
State/Province
Holstein
Country
Germany
Facility Name
Divisione di Neurochirurgia
City
Rome
Country
Italy
Facility Name
Island Hospital
City
Penang
Country
Malaysia
Facility Name
Elisabeth Ziekenhuis
City
Tilburg
Country
Netherlands
Facility Name
La Paz Hospital
City
Madrid
Country
Spain
Facility Name
Hope Hospital
City
Manchester
State/Province
Lancashire
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
32049677
Citation
Salmons HI, Galetta MS, Divi SN, Fried TB, Fang T, Hoffman E, Goyal DKC, Mangan JJ, Schroeder GD, Vaccaro AR. Are Industry-funded Studies of Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion Biased? Clin Spine Surg. 2021 Feb 1;34(1):1-3. doi: 10.1097/BSD.0000000000000946. No abstract available.
Results Reference
derived
Learn more about this trial
Study to Investigate the Performance of Cervical Arthroplasty for the Treatment of Cervical Degenerative Disc Disease
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