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Effectiveness of AlloWrap® for the Reduction of Inflammation in ACDF Procedures

Primary Purpose

Cervical Stenosis, Spondylolisthesis, Cervical Radiculopathy

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
AlloWrap® Amniotic Membrane
Sponsored by
AlloSource
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cervical Stenosis focused on measuring Anterior Cervical Discectomy and Fusion Surgery, ACDF Surgery

Eligibility Criteria

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

Inclusion Criteria:

  • Be a skeletally mature male or a non-pregnant, non-lactating female ≥18 years of age;
  • Radiographically diagnosed with cervical stenosis and/or degeneration, spondylolisthesis and/or cervical radiculopathy resulting from neural element compression as confirmed by MRI, CT, CT myelogram;
  • Radicular symptoms by history and physical exam;
  • Neck disability Index ≥30 points on a 0-50 pt scale;
  • Is scheduled/or will be scheduled to undergo an anterior cervical fusion, requiring internal fixation using an anterior cervical standalone interbody cage system;
  • Failed to gain adequate relief from non-operative treatment, including but not limited to medications, physical therapy, chiropractic care, home exercise and/or for at least 6 weeks; or the patient has progressive muscle weakness or atrophy or intractable pain;
  • Have the ability to understand the requirements of the study, to provide written informed consent, and to comply with the study protocol.

Exclusion Criteria:

  • Have a documented medical history or radiographic evidence of osteoporosis or other condition which would negatively impact the bone healing process (e.g. history of Paget's disease, osteomalacia, or other osteodystrophy) or preclude the subject from receiving screw fixation;
  • Have had or plans to have an epidural steroid injection or has taken NSAIDs ≤ 7 days prior to surgery;
  • Circulatory, cardiac, or pulmonary problems that could cause excessive surgical risk based on the opinion of the Investigator;
  • Active malignancy; Nondiscogenic source of symptoms (e.g., tumor, etc.) or undergoing treatment for tumor or boney traumatic injury to the cervical spine or a history of any invasive malignancy (except non-melanoma skin cancer), unless the patient has been treated with curative intent and there have been no clinical signs or symptoms of the malignancy for at least 5 years;
  • Acute cervical trauma ≤ 6 months prior to surgery;
  • Inflammatory disease of the cervical spine;
  • Has a history of substance abuse (recreational drugs, alcohol) that has been treated in the last 6 months before enrollment for alcohol and/or drug abuse in an in-patient substance abuse program;
  • Is currently involved in a study of another investigational product for similar purpose or has been in the previous 90 days;
  • Active infection at the operative level, or a systemic infection including prior or pending treatment for HIV, Hepatitis B or Hepatitis C;
  • Mentally compromised (e.g., being currently treated for a psychiatric disorder, senile dementia, Alzheimer's disease) in a manner that would compromise his or her ability to participate in the clinical study;
  • Currently immunologically suppressed or immunocompromised, or a medical condition requiring radiation, chemotherapy or immunosuppression;
  • Subjects who, in the opinion of the Investigator, would not be able or willing to comply with the protocol;
  • Have a history of any autoimmune disease, such as, systemic lupus erythematosus (SLE), Addison's disease, Crohn's disease, multiple sclerosis or rheumatoid arthritis;
  • Has had prior cervical spine surgery;
  • Unstable cardiovascular, renal, hepatic, endocrine and/or pulmonary disease, cancer or uncontrolled diabetes;
  • Have symptomatic disease requiring fusion of one level or > 2 levels and/or requiring fusion between levels C2-C4;
  • Has cervical deformity secondary to acute or chronic traumatic fracture or neoplasm, including vertebral, facet or posterior element fracture or dislocation;
  • Requires a concomitant posterior cervical surgery at the time of the ACDF;
  • Has any contraindications for MRI;
  • Is a ward of the state, prisoner, or transient.

Sites / Locations

  • Spine Institute of San DiegoRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Standard of Care Group

AlloWrap Group

Arm Description

Standard of Care - No AlloWrap used during surgery

AlloWrap used in surgery

Outcomes

Primary Outcome Measures

Swelling Index 1 Month
Difference of change from baseline to 1 month post operatively of soft tissue thickness/swelling, as measured by the swelling index on lateral x-rays.

Secondary Outcome Measures

Swelling Index Other Timepoints
Difference of change from baseline to discharge, 3, 6 and 12 months post operatively of soft tissue thickness/swelling, as measured by the swelling index on lateral x-rays
Neck Disability Index (NDI) Scores
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Visual Analog Scale (VAS) Scores
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Swallowing Quality of Life Questionnaire (SWAL-QOL) Scores
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Air Index Scores
The comparisons of score changes for 1, 3, 6, and 12 months from baseline will be investigated by using linear regression
Revision Surgery
The numbers and percentages of patients who underwent revision surgery as of each timepoint

Full Information

First Posted
December 22, 2020
Last Updated
February 9, 2023
Sponsor
AlloSource
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1. Study Identification

Unique Protocol Identification Number
NCT04684901
Brief Title
Effectiveness of AlloWrap® for the Reduction of Inflammation in ACDF Procedures
Official Title
A Randomized, Controlled Study to Evaluate Effectiveness of AlloWrap® Amniotic Membrane for the Reduction of Post-Operative Soft Tissue Inflammation in Two-Level Anterior Cervical Discectomy and Fusion Procedures
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 18, 2021 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
January 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AlloSource

4. Oversight

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

5. Study Description

Brief Summary
The primary objective of this study is to obtain evidence of the effectiveness of AlloWrap Amniotic Membrane in the reduction of soft tissue swelling in two-level ACDF procedures.
Detailed Description
AlloWrap® is a dual sided human amniotic membrane, procured from consented human tissue donors who elect to have scheduled cesarean births. A Human Cells, Tissues, and Cellular and Tissue-Based Product (HCT/P) as defined by the United States Food and Drug Administration (FDA) 21 CFR Part 1271, AlloWrap® is intended to provide a biologic barrier following surgical repair. Designed to meet the clinical needs of the patient and practical needs of the clinical setting amniotic based surgical barriers have been shown to contain a natural balance of cytokines that can assist the body in reducing epidural fibrosis, inflammation, and infection at the surgical site. Using AlloWrap® as a surgical barrier may result in outcomes with less scaring, potentially reducing pain and assisting the patient in returning to normal functionality while potentially making revision dissections less complicated. The purpose of this clinical study is to evaluate the use of AlloWrap® Amniotic Membrane in ACDF procedures to obtain evidence of effectiveness, defined as the reduction, and the possible prevention, of complications associated with ACDF surgery such as odynophagia and/or dysphasia that result from soft tissue inflammation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cervical Stenosis, Spondylolisthesis, Cervical Radiculopathy, Cervical Disc Disorder
Keywords
Anterior Cervical Discectomy and Fusion Surgery, ACDF Surgery

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard of Care Group
Arm Type
No Intervention
Arm Description
Standard of Care - No AlloWrap used during surgery
Arm Title
AlloWrap Group
Arm Type
Experimental
Arm Description
AlloWrap used in surgery
Intervention Type
Other
Intervention Name(s)
AlloWrap® Amniotic Membrane
Intervention Description
AlloWrap is a human amniotic membrane designed to provide a biologic barrier following surgical repair.
Primary Outcome Measure Information:
Title
Swelling Index 1 Month
Description
Difference of change from baseline to 1 month post operatively of soft tissue thickness/swelling, as measured by the swelling index on lateral x-rays.
Time Frame
1 month
Secondary Outcome Measure Information:
Title
Swelling Index Other Timepoints
Description
Difference of change from baseline to discharge, 3, 6 and 12 months post operatively of soft tissue thickness/swelling, as measured by the swelling index on lateral x-rays
Time Frame
3, 6 and 12 months
Title
Neck Disability Index (NDI) Scores
Description
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Time Frame
1, 3, 6 and 12 months
Title
Visual Analog Scale (VAS) Scores
Description
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Time Frame
1, 3, 6 and 12 months
Title
Swallowing Quality of Life Questionnaire (SWAL-QOL) Scores
Description
The comparisons of score changes between groups at each timepoint will be investigated by employing linear regression
Time Frame
1, 3, 6 and 12 months
Title
Air Index Scores
Description
The comparisons of score changes for 1, 3, 6, and 12 months from baseline will be investigated by using linear regression
Time Frame
1, 3, 6 and 12 months
Title
Revision Surgery
Description
The numbers and percentages of patients who underwent revision surgery as of each timepoint
Time Frame
1, 3, 6 and 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be a skeletally mature male or a non-pregnant, non-lactating female ≥18 years of age; Radiographically diagnosed with cervical stenosis or cervical disc disorder and/or degeneration, spondylolisthesis and/or cervical radiculopathy resulting from neural element compression as confirmed by MRI, CT, CT myelogram; Neurological dysfunction or radicular symptoms by history and physical exam; Is scheduled/or will be scheduled to undergo an anterior cervical fusion, requiring internal fixation using an anterior cervical standalone interbody cage system; Failed to gain adequate relief from non-operative treatment, including but not limited to medications, physical therapy, chiropractic care, home exercise and/or for at least 6 weeks; or the patient has progressive muscle weakness or atrophy or intractable pain; Have the ability to understand the requirements of the study, to provide written informed consent, and to comply with the study protocol. Exclusion Criteria: Have a documented medical history or radiographic evidence of osteoporosis or other condition which would negatively impact the bone healing process (e.g. history of Paget's disease, osteomalacia, or other osteodystrophy) or preclude the subject from receiving screw fixation; Have had or plans to have an epidural steroid injection or has taken NSAIDs ≤ 7 days prior to surgery; Circulatory, cardiac, or pulmonary problems that could cause excessive surgical risk based on the opinion of the Investigator; Active malignancy; Nondiscogenic source of symptoms (e.g., tumor, etc.) or undergoing treatment for tumor or boney traumatic injury to the cervical spine or a history of any invasive malignancy (except non-melanoma skin cancer), unless the patient has been treated with curative intent and there have been no clinical signs or symptoms of the malignancy for at least 5 years; Acute cervical trauma ≤ 6 months prior to surgery; Inflammatory disease of the cervical spine; Has a history of substance abuse (recreational drugs, alcohol) that has been treated in the last 6 months before enrollment for alcohol and/or drug abuse in an in-patient substance abuse program; Is currently involved in a study of another investigational product for similar purpose or has been in the previous 90 days; Active infection at the operative level, or a systemic infection including prior or pending treatment for HIV, Hepatitis B or Hepatitis C; Mentally compromised (e.g., being currently treated for a psychiatric disorder, senile dementia, Alzheimer's disease) in a manner that would compromise his or her ability to participate in the clinical study; Currently immunologically suppressed or immunocompromised, or a medical condition requiring radiation, chemotherapy or immunosuppression; Subjects who, in the opinion of the Investigator, would not be able or willing to comply with the protocol; Have a history of any autoimmune disease, such as, systemic lupus erythematosus (SLE), Addison's disease, Crohn's disease, multiple sclerosis or rheumatoid arthritis; Has had prior cervical spine surgery; Unstable cardiovascular, renal, hepatic, endocrine and/or pulmonary disease, cancer or uncontrolled diabetes; Have symptomatic disease requiring fusion of one level or > 2 levels and/or requiring fusion between levels C2-C4; Has cervical deformity secondary to acute or chronic traumatic fracture or neoplasm, including vertebral, facet or posterior element fracture or dislocation; Requires a concomitant posterior cervical surgery at the time of the ACDF; Has any contraindications for MRI; Is a ward of the state, prisoner, or transient.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Claire McFadyen, MPH
Phone
720. 873. 2452
Email
cmcfadyen@allosource.org
First Name & Middle Initial & Last Name or Official Title & Degree
Elizabeth Esterl, DNP, MS, RN
Phone
720. 732.6231
Email
eesterl@allosource.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth Esterl, DNP, MS, RN
Organizational Affiliation
AlloSource
Official's Role
Study Director
Facility Information:
Facility Name
Spine Institute of San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92120
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Paul D Kim, MD
Phone
619-265-7912
Ext
3
Email
paul@siosd.com

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No IPD will be shared with other researchers

Learn more about this trial

Effectiveness of AlloWrap® for the Reduction of Inflammation in ACDF Procedures

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