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Safety and Efficacy of the ISS Sleeve Augmentation Technique in the Treatment of Thoracolumbar Osteopenic Fractures

Primary Purpose

Osteoporotic Fracture of Vertebra

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Augmentation with the ISS Study System
Augmentation with PMMA
Sponsored by
Nexilis AG
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Osteoporotic Fracture of Vertebra focused on measuring bone augmentation, spine, pedicle screw, osteoporosis

Eligibility Criteria

50 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patient

  1. Age ≥ 50 and ≤ 85, male and female patients
  2. Subject is able to understand the risks and benefits of participating in the study and is willing to provide written informed consent.
  3. Psychosocially, mentally and physically able to fully comply with the protocol requirements for the duration of the study including adhering to scheduled visits, treatment plan, completing forms and other study procedures.

    Fracture

  4. Fractures between the 10th thoracic and 4th lumbar vertebra, both included
  5. Bone mineral density equal or above the threshold of 60 mgHA/ccm (central assessment of the screening qCT scan).
  6. Fractures with the indication and possibility for augmented bi-segmental dorsal pedicle screw and rod stabilization including kyphoplasty in the broken vertebra
  7. All fractures where pedicle screws can be used

Exclusion Criteria:

Patient

  1. Substance use disorders (incl. tobacco abuse >20 cigarettes/day) and alcohol abuse disorders within the last 2 years before randomization.
  2. BMI > 35
  3. Permanent or progressive neurologic deficits (incl. upper motor neuron disease and myelopathy)
  4. Known Creutzfeldt Jacob Disease
  5. Systemic infections:

    • Known infection with human immunodeficiency virus (HIV) or, hepatitis B or C requiring treatment
    • Any active infection requiring the use of parenteral anti-microbial agents or that is > grade 2 Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03
  6. Rheumatoid arthritis or known disorders of bone metabolism (excl. osteopenia/osteoporosis, Vitamin D deficiency)
  7. Radiation therapy of the spine in medical history
  8. Contraindications to pedicle screw and rod stabilization
  9. Breast feeding, pregnancy or child-bearing potential (female patients of childbearing potential and male patients with a partner of child bearing potential must agree to use a highly effective contraceptive method).
  10. A compromised immune system or a therapy with systemic corticosteroids or immunosuppressants
  11. Active malignancy or history of malignancy (excl. Basalioma as a semi-malignant tumor) <2 years ago from time of randomization
  12. Known allergy to any component of the investigational device
  13. History of severe allergy, anaphylactic reactions and hypersensitivity reactions experienced in previous surgical interventions.
  14. Other concurrent severe and/or uncontrolled medical conditions (e.g. insufficiently treated diabetes (HbA1c > 8 %), active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol
  15. Participation in other clinical investigations for drugs or devices

    Fracture

  16. Fracture age > 3 months
  17. Major surgery to the spine planned for at least 12 months following enrolment
  18. Any treatment of the fracture other than that specified in the inclusion criteria (e.g. index screws in the fractured vertebra, vertebroplasty, additional ventral stabilization)
  19. Severe spinal deformations or fusion at the target vertebral or adjacent segments
  20. Previous operations at the spine in the target or adjacent vertebrae
  21. Infections or inflammatory processes at vertebral bodies

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Other

    Other

    Arm Label

    Treatment with ISS Sleeve

    Treatment with PMMA

    Arm Description

    The biocompatible, resorbable ISS sleeve is used for augmentation to enhance screw anchorage. It is melted into the trabecular bone structure of the osteoporotic vertebra using ultrasound. A standard pedicle screw is inserted into the sleeve.

    The bone cement Polymethylmethacrylat (PMMA) that is injected into the osteoporotic vertebra.PMMA augmentation of pedicle screws is done using standard cannulated and perforated pedicle screws. The cancellous bone surrounding the screw is enhanced with PMMA bone cement to increase screw anchorage.

    Outcomes

    Primary Outcome Measures

    Change of the bi-segmental kyphosis angle (Correction Loss)
    The evaluation will be done from a comparison of plain x-rays taken post-operatively before discharge (day 3 (± 1 day)) and 6 months post operatively both in upright position. The correction loss of the bi-segmental kyphosis angle will be compared in the ISS Sleeve screw augmentation group and the standard PMMA screw augmentation group.

    Secondary Outcome Measures

    Time of x-ray exposure
    accumulated duration; from skin incision to skin suture) of patients and medical personnel.
    Compression rate
    Compression rate of the anterior vertebral body height measured in the lateral x-ray
    Screw loosening
    Screw loosening measured following the method of Aghayev et al. The angle between the axes of the pedicle screws and the cranial endplate are measured
    Evaluation of the functional outcome with the Oswestry Disability
    Oswestry Disability Index (ODI)
    Evaluation of the pain level
    Pain Scale as Visual Analogue Scale (VAS)
    Evaluation of the clinical outcome
    SF-12
    Treatment success
    composite endpoint including the correction loss of the bi-segmental kyphosis angle, the ODI and the occurrence of any device-related serious adverse events

    Full Information

    First Posted
    July 22, 2020
    Last Updated
    May 10, 2022
    Sponsor
    Nexilis AG
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04495439
    Brief Title
    Safety and Efficacy of the ISS Sleeve Augmentation Technique in the Treatment of Thoracolumbar Osteopenic Fractures
    Official Title
    Safety and Efficacy of the New ISS Sleeve Augmentation Technique in the Treatment of Osteoporotic/Osteopenic Vertebral Fractures in the Thoraco-lumbar Spine: A Pilot Study and Subsequent Comparison to the Standard PMMA-Screw Augmentation
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    February 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 1, 2022 (Anticipated)
    Primary Completion Date
    June 1, 2025 (Anticipated)
    Study Completion Date
    June 1, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Nexilis AG

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    Implant anchorage is difficult in patient with osteoporotic bone. To improve the implant bone interface, the ISS stabilization system has been developed. The goal of the study is to investigate the efficacy the ISS augmentation compared to the standard PMMA augmentation of pedicle screws in the treatment of patients suffering from osteoporotic/osteopenic thoracolumbar fracture. The study has two phases, a pilot phase followed by a pivotal phase. The data will be used to measure clinical and radiological performance and usability of both systems.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Osteoporotic Fracture of Vertebra
    Keywords
    bone augmentation, spine, pedicle screw, osteoporosis

    7. Study Design

    Primary Purpose
    Other
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Investigator
    Allocation
    Randomized
    Enrollment
    66 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment with ISS Sleeve
    Arm Type
    Other
    Arm Description
    The biocompatible, resorbable ISS sleeve is used for augmentation to enhance screw anchorage. It is melted into the trabecular bone structure of the osteoporotic vertebra using ultrasound. A standard pedicle screw is inserted into the sleeve.
    Arm Title
    Treatment with PMMA
    Arm Type
    Other
    Arm Description
    The bone cement Polymethylmethacrylat (PMMA) that is injected into the osteoporotic vertebra.PMMA augmentation of pedicle screws is done using standard cannulated and perforated pedicle screws. The cancellous bone surrounding the screw is enhanced with PMMA bone cement to increase screw anchorage.
    Intervention Type
    Device
    Intervention Name(s)
    Augmentation with the ISS Study System
    Intervention Description
    Augmentation with the ISS Study System
    Intervention Type
    Other
    Intervention Name(s)
    Augmentation with PMMA
    Intervention Description
    Augmentation with PMMA (standard)
    Primary Outcome Measure Information:
    Title
    Change of the bi-segmental kyphosis angle (Correction Loss)
    Description
    The evaluation will be done from a comparison of plain x-rays taken post-operatively before discharge (day 3 (± 1 day)) and 6 months post operatively both in upright position. The correction loss of the bi-segmental kyphosis angle will be compared in the ISS Sleeve screw augmentation group and the standard PMMA screw augmentation group.
    Time Frame
    Day 3 to 6 Months
    Secondary Outcome Measure Information:
    Title
    Time of x-ray exposure
    Description
    accumulated duration; from skin incision to skin suture) of patients and medical personnel.
    Time Frame
    Surgery
    Title
    Compression rate
    Description
    Compression rate of the anterior vertebral body height measured in the lateral x-ray
    Time Frame
    post-operatively before discharge (day 3 (± 1 day)) compared to 3, 6 and 12 months postoperatively
    Title
    Screw loosening
    Description
    Screw loosening measured following the method of Aghayev et al. The angle between the axes of the pedicle screws and the cranial endplate are measured
    Time Frame
    up to 12 months
    Title
    Evaluation of the functional outcome with the Oswestry Disability
    Description
    Oswestry Disability Index (ODI)
    Time Frame
    baseline, 3 months, 6 months, 12 months
    Title
    Evaluation of the pain level
    Description
    Pain Scale as Visual Analogue Scale (VAS)
    Time Frame
    baseline, 3 months, 6 months, 12 months
    Title
    Evaluation of the clinical outcome
    Description
    SF-12
    Time Frame
    baseline, 3 months, 6 months, 12 months
    Title
    Treatment success
    Description
    composite endpoint including the correction loss of the bi-segmental kyphosis angle, the ODI and the occurrence of any device-related serious adverse events
    Time Frame
    at 6 and 12 months postoperatively

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    50 Years
    Maximum Age & Unit of Time
    85 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Patient Age ≥ 50 and ≤ 85, male and female patients Subject is able to understand the risks and benefits of participating in the study and is willing to provide written informed consent. Psychosocially, mentally and physically able to fully comply with the protocol requirements for the duration of the study including adhering to scheduled visits, treatment plan, completing forms and other study procedures. Fracture Fractures between the 10th thoracic and 4th lumbar vertebra, both included Bone mineral density equal or above the threshold of 60 mgHA/ccm (central assessment of the screening qCT scan). Fractures with the indication and possibility for augmented bi-segmental dorsal pedicle screw and rod stabilization including kyphoplasty in the broken vertebra All fractures where pedicle screws can be used Exclusion Criteria: Patient Substance use disorders (incl. tobacco abuse >20 cigarettes/day) and alcohol abuse disorders within the last 2 years before randomization. BMI > 35 Permanent or progressive neurologic deficits (incl. upper motor neuron disease and myelopathy) Known Creutzfeldt Jacob Disease Systemic infections: Known infection with human immunodeficiency virus (HIV) or, hepatitis B or C requiring treatment Any active infection requiring the use of parenteral anti-microbial agents or that is > grade 2 Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03 Rheumatoid arthritis or known disorders of bone metabolism (excl. osteopenia/osteoporosis, Vitamin D deficiency) Radiation therapy of the spine in medical history Contraindications to pedicle screw and rod stabilization Breast feeding, pregnancy or child-bearing potential (female patients of childbearing potential and male patients with a partner of child bearing potential must agree to use a highly effective contraceptive method). A compromised immune system or a therapy with systemic corticosteroids or immunosuppressants Active malignancy or history of malignancy (excl. Basalioma as a semi-malignant tumor) <2 years ago from time of randomization Known allergy to any component of the investigational device History of severe allergy, anaphylactic reactions and hypersensitivity reactions experienced in previous surgical interventions. Other concurrent severe and/or uncontrolled medical conditions (e.g. insufficiently treated diabetes (HbA1c > 8 %), active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol Participation in other clinical investigations for drugs or devices Fracture Fracture age > 3 months Major surgery to the spine planned for at least 12 months following enrolment Any treatment of the fracture other than that specified in the inclusion criteria (e.g. index screws in the fractured vertebra, vertebroplasty, additional ventral stabilization) Severe spinal deformations or fusion at the target vertebral or adjacent segments Previous operations at the spine in the target or adjacent vertebrae Infections or inflammatory processes at vertebral bodies
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Leanna Caron
    Phone
    +41619220508
    Email
    leanna.caron@nexilis.ch
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Richard Lindtner, M.D
    Organizational Affiliation
    Department of Trauma Surgery, Medical University of Innsbruck, Austria
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Safety and Efficacy of the ISS Sleeve Augmentation Technique in the Treatment of Thoracolumbar Osteopenic Fractures

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