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PCM Cervical Disc System

Primary Purpose

Radiculopathy, Myelopathy

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Anterior Cervical Discectomy and Fusion (ACDF)
PCM Cervical Disc
Sponsored by
NuVasive
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Radiculopathy

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age 18-65 years;
  • Diagnosis of radiculopathy or myelopathy of the cervical spine between C3-4 and C7-T1;
  • Symptomatic at only one level from C3-C4 to C7-T1;
  • 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 conservative treatment;
  • Baseline NDI score of ≥30/100;
  • Radiographically determined pathology at level to be treated correlating to primary symptoms, including at least one of the following: decreased disc height, degenerative spondylosis on CT or MRI, or disc herniation;
  • Appropriate for treatment using an anterior surgical approach, including having no more than one previous anterior surgical approach to the cervical spine;
  • Ability and willingness to comply with follow-up regimen; and
  • Written informed consent given by subject or subject's legally authorized representative.

Exclusion Criteria:

  • Infection at the site of surgery;
  • History of, or anticipated treatment for, active systemic infection, including HIV infection or hepatitis C;
  • Prior attempted or completed cervical spine surgery, except (1) laminoforaminotomy with less than one-third facetectomy at any level, or (2) a successful single-level anterior cervical fusion;
  • More than one immobile vertebral level between C1-T1 from any cause, including but not limited to congenital abnormalities, osteoarthritic "spontaneous" fusions, and prior cervical spinal fusions;
  • Previous trauma to the C3-T1 levels resulting in significant bony or disco-ligamentous cervical spine injury;
  • Axial neck pain in the absence of other symptoms of radiculopathy or myelopathy justifying the need for surgical intervention;
  • Radiographic confirmation of severe facet joint disease or degeneration.
  • Osteoporosis:
  • Severe diabetes mellitus requiring daily insulin management;
  • Active malignancy: 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;
  • Tumor as source of symptoms;
  • Symptomatic DDD or significant cervical spondylosis at two or more levels;
  • Known or suspected allergy to cobalt, chromium, molybdenum, titanium, or polyethylene;
  • Severe myelopathy to the extent that the patient is wheelchair bound;
  • Pregnant (verified in patients of childbearing potential by a negative urine pregnancy test when preadmission testing is obtained), or interested in becoming pregnant during the duration of the study;
  • Autoimmune disorders that impact the musculoskeletal system (e.g., lupus, rheumatoid arthritis; ankylosing spondylitis);
  • Spinal axis disease (thoracic or lumbar) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure;
  • Other degenerative joint disease (e.g. shoulder, hip, knee) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure;
  • Previous spine surgery within the 6 months preceding the cervical randomized procedure;
  • Current or recent history of substance abuse (drug or alcohol);
  • Morbid obesity, defined as body mass index ("BMI") > 40 or more than 100 lbs. over ideal body weight;
  • Currently using, or planning to use, bone growth stimulators in the cervical spine;
  • Use of any other investigational drug or medical device within the last 30 days prior to surgery
  • Currently a prisoner; or
  • Currently pursuing personal litigation related to the neck or cervical spine injury; however, involvement in worker's compensation related litigation is not a required exclusion.

Sites / Locations

  • Tower Orthopedics
  • Spine Group Beverly Hills
  • Denver Spine
  • Walter Reed Army Medical Center
  • Midwest Orthopedic Associates at Rush
  • Chicago Back Institute
  • Goodman Campbell Brain and Spine
  • Towson Orthopedic Associates
  • Wm. Beaumont Hospital
  • Mayo Clinic
  • Columbia Orthopedic Research
  • Buffalo Spine Surgery
  • Institute for Spine Care
  • The Cleveland Clinic
  • OrthoNeuro
  • Neuroscience Specialists
  • The Rothman Institute
  • Neurosurgical Associates of San Antonio
  • Scott and White Memorial Hospital
  • Virginia Brain and Spine
  • Olympia Othopaedic Associates
  • Madigan Army Medical Center
  • NeuroSpine Center of Wisconsin

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

PCM Cervical Disc - Investigational

ACDF - Control Group

Arm Description

PCM Cervical Disc replacement at one level from C3 to T1

Anterior cervical discectomy and fusion (ACDF) at one level from C3 to T1

Outcomes

Primary Outcome Measures

Individual Patient Overall Success
Individual patient overall success defined as ≥20% improvement in Neck Disability Index (NDI) from preoperative score, no device failures requiring revision, reoperation or removal, and the absence of radiographic or major complications during the 24-month follow-up period.

Secondary Outcome Measures

Neck Pain Visual Analog Scale
Improvement of ≥20mm in neck pain at 24 months compared to baseline.
Mean Neck Pain Visual Analog Scale
Mean neck pain at 24 months on a 0-100 mm Visual Analog Scale (lower value is better).
Worst Arm Pain Visual Analog Scale
Improvement of ≥20mm in worst arm pain at 24 months compared to baseline.
Mean Worst Arm Pain Visual Analog Scale
Mean worst arm pain at 24 months on a 0-100mm Visual Analog Scale (lower value is better).
Clinically Significant Improvement on Neck Disability Index (NDI)
Improvement in NDI of ≥20% at 24 months compared to baseline.
Clinically Significant Improvement on Neck Disability Index (NDI)
Improvement in NDI of ≥15-points at 24 months compared to baseline.
Mean Neck Disability Index (NDI)
Mean NDI at 24 months on a 0-100 scale (lower value is better).
Clinically Significant Improvement on SF-36 Physical Component Summary (PCS)
Improvement of ≥15% on SF-36 PCS at 24 months compared to baseline.
Mean SF-36 Physical Component Summary (PCS)
Mean SF-36 PCS at 24 months on a 0-100 scale (lower value is better).
Clinically Significant Improvement on SF-36 Mental Component Summary (MCS)
Improvement of ≥15% on the SF-36 MCS at 24 months compared to baseline.
Mean SF-36 Mental Component Summary (MCS)
Mean SF-36 MCS at 24 months on a 0-100 scale (lower value is better).
Dysphagia for Swallowing
Mean dysphagia for swallowing at 24 months on a 0-100mm Visual Analog Scale (lower value is better).
Patient Satisfaction
Mean Patient Satisfaction at 24 months on a 0-100 Visual Analog Scale (higher value is better).
Nurick's Classification of Disability (Myelopathy)
Maintenance or improvement in Nurick's Classification from baseline to 24 months. Nurick's classification is a six-point scale, graded 0 to 5. A grade of 0 indicates no symptoms at all, while a grade of 5 is a bed or chair-bound patient. A patient "maintained" if their Nurick classification grade remained the same or "improved" if it decreased from baseline to 24 months.
Flexion/Extension Range of Motion at the Operative Level
Mean flexion/extension range of motion at operative level at 24 months. The operative level is defined as the cervical spinal level at which the surgical procedure was performed.

Full Information

First Posted
December 19, 2007
Last Updated
June 8, 2015
Sponsor
NuVasive
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1. Study Identification

Unique Protocol Identification Number
NCT00578812
Brief Title
PCM Cervical Disc System
Official Title
A Prospective, Randomized, Controlled Clinical Investigation Comparing PCM® Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: 2 Year Results From the US IDE Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2015
Overall Recruitment Status
Completed
Study Start Date
January 2005 (undefined)
Primary Completion Date
March 2010 (Actual)
Study Completion Date
August 2014 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The PCM Cervical Disc was studied in a prospective, multicenter, randomized FDA-approved investigational device exemption (IDE) clinical trial conducted in the United States to evaluate longitudinal outcomes over 2 years comparatively between the PCM Cervical Disc and anterior cervical discectomy and fusion (ACDF) with allograft and plate. Patients with adjacent or non-adjacent prior fusion were allowed. A total of 416 patients with a degenerated cervical disc at one level from C3-C4 to C7-T1 were enrolled in the clinical trial and 403 were treated. Patients were randomly assigned to be treated either with the PCM Cervical Disc or ACDF.
Detailed Description
The PCM Cervical Disc was studied in a prospective, multicenter, randomized FDA-approved investigational device exemption (IDE) clinical trial conducted in the United States to evaluate longitudinal outcomes over 2 years comparatively between the PCM Cervical Disc and anterior cervical discectomy and fusion (ACDF) with allograft and plate. Patients with adjacent or non-adjacent prior fusion were allowed. A total of 416 patients with a degenerated cervical disc at one level from C3-C4 to C7-T1 were enrolled in the clinical trial and 403 were treated. Patients were randomly assigned to be treated either with the PCM Cervical Disc or ACDF. Patients were evaluated before surgery, during the operation, immediately after surgery, and then at 6 weeks, 3 months, 6 months, 12 months and 24 months, and yearly after surgery. The patients were recommended to have a physical therapy program for non-impact exercises and active range of motion exercises after surgery. Patients were also instructed to avoid repetitive cervical flexion and extension bending and lateral bending and rotation for 6 weeks following surgery. The safety of the PCM Cervical Disc was assessed by comparing the adverse events, any additional surgical procedures, and the neurological outcomes to those in the ACDF control group. The effectiveness of the PCM Cervical Disc was assessed by evaluating patients' pain and function outcomes using a standard questionnaire, the Neck Disability Index (NDI), the severity of neck and arm pain based on a Visual Analog Scale (VAS) assessment, quality of life using a standard questionnaire, the Short Form-36 (SF-36), as well as a patient satisfaction questionnaire compared to the ACDF control group. In addition, the patients were evaluated using radiographic evaluations, including spinal range of motion, spinal disc height, device displacement or migration, spinal fusion status, and heterotopic ossification (abnormal bone formation). The primary endpoint of the IDE trial was a composite measure termed "overall success," which was evaluated at 24 months postoperatively, and was defined as at least 20% improvement in neck disability index (NDI) from preoperative score; absence of reoperation, revision, or removal; maintenance or improvement in neurological status; and absence of radiographic or major complications during the 24-month follow-up period. On October 26, 2012, the FDA granted Premarket Approval (PMA) for the PCM Cervical Disc. PCM Cervical Disc is indicated for use in skeletally mature patients for reconstruction of a degenerated cervical disc at one level from C3-C4 to C6-C7 following single-level discectomy for intractable radiculopathy (arm pain and/or a neurological deficit), with or without neck pain, or myelopathy due to a single-level abnormality localized to the disc space, and manifested by at least one of the following conditions confirmed by radiographic imaging (CT, MRI, X-rays): herniated nucleus pulposus, spondylosis (defined by the presence of osteophytes), and/or visible loss of disc height as compared to adjacent levels.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Radiculopathy, Myelopathy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
PCM Cervical Disc - Investigational
Arm Type
Experimental
Arm Description
PCM Cervical Disc replacement at one level from C3 to T1
Arm Title
ACDF - Control Group
Arm Type
Active Comparator
Arm Description
Anterior cervical discectomy and fusion (ACDF) at one level from C3 to T1
Intervention Type
Device
Intervention Name(s)
Anterior Cervical Discectomy and Fusion (ACDF)
Intervention Description
Anterior cervical discectomy and fusion (ACDF) using a cervical plate and bone graft in patients with degenerated cervical discs and neurological symptoms at one level from C3 to T1
Intervention Type
Device
Intervention Name(s)
PCM Cervical Disc
Intervention Description
PCM Cervical Disc replacement in patients with degenerated cervical discs and neurological symptoms at one level from C3 to T1
Primary Outcome Measure Information:
Title
Individual Patient Overall Success
Description
Individual patient overall success defined as ≥20% improvement in Neck Disability Index (NDI) from preoperative score, no device failures requiring revision, reoperation or removal, and the absence of radiographic or major complications during the 24-month follow-up period.
Time Frame
24 Months
Secondary Outcome Measure Information:
Title
Neck Pain Visual Analog Scale
Description
Improvement of ≥20mm in neck pain at 24 months compared to baseline.
Time Frame
24 Months
Title
Mean Neck Pain Visual Analog Scale
Description
Mean neck pain at 24 months on a 0-100 mm Visual Analog Scale (lower value is better).
Time Frame
24 Months
Title
Worst Arm Pain Visual Analog Scale
Description
Improvement of ≥20mm in worst arm pain at 24 months compared to baseline.
Time Frame
24 Months
Title
Mean Worst Arm Pain Visual Analog Scale
Description
Mean worst arm pain at 24 months on a 0-100mm Visual Analog Scale (lower value is better).
Time Frame
24 Months
Title
Clinically Significant Improvement on Neck Disability Index (NDI)
Description
Improvement in NDI of ≥20% at 24 months compared to baseline.
Time Frame
24 Months
Title
Clinically Significant Improvement on Neck Disability Index (NDI)
Description
Improvement in NDI of ≥15-points at 24 months compared to baseline.
Time Frame
24 Months
Title
Mean Neck Disability Index (NDI)
Description
Mean NDI at 24 months on a 0-100 scale (lower value is better).
Time Frame
24 Months
Title
Clinically Significant Improvement on SF-36 Physical Component Summary (PCS)
Description
Improvement of ≥15% on SF-36 PCS at 24 months compared to baseline.
Time Frame
24 Months
Title
Mean SF-36 Physical Component Summary (PCS)
Description
Mean SF-36 PCS at 24 months on a 0-100 scale (lower value is better).
Time Frame
24 Months
Title
Clinically Significant Improvement on SF-36 Mental Component Summary (MCS)
Description
Improvement of ≥15% on the SF-36 MCS at 24 months compared to baseline.
Time Frame
24 Months
Title
Mean SF-36 Mental Component Summary (MCS)
Description
Mean SF-36 MCS at 24 months on a 0-100 scale (lower value is better).
Time Frame
24 Months
Title
Dysphagia for Swallowing
Description
Mean dysphagia for swallowing at 24 months on a 0-100mm Visual Analog Scale (lower value is better).
Time Frame
24 Months
Title
Patient Satisfaction
Description
Mean Patient Satisfaction at 24 months on a 0-100 Visual Analog Scale (higher value is better).
Time Frame
24 Months
Title
Nurick's Classification of Disability (Myelopathy)
Description
Maintenance or improvement in Nurick's Classification from baseline to 24 months. Nurick's classification is a six-point scale, graded 0 to 5. A grade of 0 indicates no symptoms at all, while a grade of 5 is a bed or chair-bound patient. A patient "maintained" if their Nurick classification grade remained the same or "improved" if it decreased from baseline to 24 months.
Time Frame
24 Months
Title
Flexion/Extension Range of Motion at the Operative Level
Description
Mean flexion/extension range of motion at operative level at 24 months. The operative level is defined as the cervical spinal level at which the surgical procedure was performed.
Time Frame
24 Months

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: Age 18-65 years; Diagnosis of radiculopathy or myelopathy of the cervical spine between C3-4 and C7-T1; Symptomatic at only one level from C3-C4 to C7-T1; 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 conservative treatment; Baseline NDI score of ≥30/100; Radiographically determined pathology at level to be treated correlating to primary symptoms, including at least one of the following: decreased disc height, degenerative spondylosis on CT or MRI, or disc herniation; Appropriate for treatment using an anterior surgical approach, including having no more than one previous anterior surgical approach to the cervical spine; Ability and willingness to comply with follow-up regimen; and Written informed consent given by subject or subject's legally authorized representative. Exclusion Criteria: Infection at the site of surgery; History of, or anticipated treatment for, active systemic infection, including HIV infection or hepatitis C; Prior attempted or completed cervical spine surgery, except (1) laminoforaminotomy with less than one-third facetectomy at any level, or (2) a successful single-level anterior cervical fusion; More than one immobile vertebral level between C1-T1 from any cause, including but not limited to congenital abnormalities, osteoarthritic "spontaneous" fusions, and prior cervical spinal fusions; Previous trauma to the C3-T1 levels resulting in significant bony or disco-ligamentous cervical spine injury; Axial neck pain in the absence of other symptoms of radiculopathy or myelopathy justifying the need for surgical intervention; Radiographic confirmation of severe facet joint disease or degeneration. Osteoporosis: Severe diabetes mellitus requiring daily insulin management; Active malignancy: 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; Tumor as source of symptoms; Symptomatic DDD or significant cervical spondylosis at two or more levels; Known or suspected allergy to cobalt, chromium, molybdenum, titanium, or polyethylene; Severe myelopathy to the extent that the patient is wheelchair bound; Pregnant (verified in patients of childbearing potential by a negative urine pregnancy test when preadmission testing is obtained), or interested in becoming pregnant during the duration of the study; Autoimmune disorders that impact the musculoskeletal system (e.g., lupus, rheumatoid arthritis; ankylosing spondylitis); Spinal axis disease (thoracic or lumbar) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure; Other degenerative joint disease (e.g. shoulder, hip, knee) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure; Previous spine surgery within the 6 months preceding the cervical randomized procedure; Current or recent history of substance abuse (drug or alcohol); Morbid obesity, defined as body mass index ("BMI") > 40 or more than 100 lbs. over ideal body weight; Currently using, or planning to use, bone growth stimulators in the cervical spine; Use of any other investigational drug or medical device within the last 30 days prior to surgery Currently a prisoner; or Currently pursuing personal litigation related to the neck or cervical spine injury; however, involvement in worker's compensation related litigation is not a required exclusion.
Facility Information:
Facility Name
Tower Orthopedics
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Facility Name
Spine Group Beverly Hills
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90212
Country
United States
Facility Name
Denver Spine
City
Greenwood Village
State/Province
Colorado
ZIP/Postal Code
80111
Country
United States
Facility Name
Walter Reed Army Medical Center
City
Washington, DC
State/Province
District of Columbia
ZIP/Postal Code
20307
Country
United States
Facility Name
Midwest Orthopedic Associates at Rush
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Chicago Back Institute
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60625
Country
United States
Facility Name
Goodman Campbell Brain and Spine
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46260
Country
United States
Facility Name
Towson Orthopedic Associates
City
Towson
State/Province
Maryland
ZIP/Postal Code
21204
Country
United States
Facility Name
Wm. Beaumont Hospital
City
Southfield
State/Province
Michigan
ZIP/Postal Code
48034
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Columbia Orthopedic Research
City
Columbia
State/Province
Missouri
ZIP/Postal Code
65201
Country
United States
Facility Name
Buffalo Spine Surgery
City
Lockport
State/Province
New York
ZIP/Postal Code
14094
Country
United States
Facility Name
Institute for Spine Care
City
Syracuse
State/Province
New York
ZIP/Postal Code
13202
Country
United States
Facility Name
The Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
OrthoNeuro
City
Westerville
State/Province
Ohio
ZIP/Postal Code
43054
Country
United States
Facility Name
Neuroscience Specialists
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73120
Country
United States
Facility Name
The Rothman Institute
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Neurosurgical Associates of San Antonio
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Scott and White Memorial Hospital
City
Temple
State/Province
Texas
ZIP/Postal Code
76508
Country
United States
Facility Name
Virginia Brain and Spine
City
Winchester
State/Province
Virginia
ZIP/Postal Code
22601
Country
United States
Facility Name
Olympia Othopaedic Associates
City
Olympia
State/Province
Washington
ZIP/Postal Code
98502
Country
United States
Facility Name
Madigan Army Medical Center
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98431-1100
Country
United States
Facility Name
NeuroSpine Center of Wisconsin
City
Appleton
State/Province
Wisconsin
ZIP/Postal Code
54913
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.nuvasive.com
Description
NuVasive

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PCM Cervical Disc System

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