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Safety and Efficacy Study Comparing ProDisc-C to ACDF Surgery to Treat SCDD

Primary Purpose

Symptomatic Cervical Disc Disease

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Total Disc Replacement
ACDF
Sponsored by
Synthes USA HQ, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Symptomatic Cervical Disc Disease focused on measuring ProDisc, ProDisc-C, Spinal Fusion, Anterior cervical diskectomy, Cervical spine, Disc disease, Implant, Degenerative disc disease, Intervertebral disc

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Symptomatic cervical disc disease (SCDD) in one vertebral level between C3-C7 defined as: Neck or arm (radicular) pain; and/or a functional/neurological deficit with at least one of the following conditions confirmed by imaging (CT, MRI or X-rays): Herniated nucleus pulposus; Spondylosis (defined by the presence of osteophytes); and/or Loss of disc height. Age between 18 and 60 years. Unresponsive to non-operative treatment for approximately six weeks or has the presence of progressive symptoms or signs of nerve root/spinal cord compression in the face of conservative treatment. NDI score greater than or equal to 15/50 (30%). Psychosocially, mentally and physically able to fully comply with the protocol including adhering to follow-up schedule and requirements and filling out forms. Signed informed consent. Exclusion Criteria: More than one vertebral level requiring treatment. Marked cervical instability on resting lateral or flexion/extension radiographs: translation greater than 3mm and/or greater than 11 degrees of rotational difference to that of either adjacent level. Has a fused level adjacent to the level to be treated. Radiographic confirmation of severe facet joint disease or degeneration. Known allergy to cobalt, chromium, molybdenum, titanium or polyethylene. Clinically comprised vertebral bodies at the affected level(s) due to current or past trauma, e.g. by the radiographic appearance of fracture callus, malunion or nonunion. Prior surgery at the level to be treated. Severe spondylosis at the level to be treated as characterized by any of the following: Bridging osteophytes; A loss of disc height greater than 50%; or Absence of motion (<2°). Neck or arm pain of unknown etiology. Osteoporosis: A screening questionnaire for osteoporosis, SCORE (Simple Calculated Osteoporosis Risk Estimation), will be used to screen patients who require a DEXA (dual energy x-ray absoptiometry) bone mineral density measurement. If DEXA is required, exclusion will be defined as a DEXA bone density measured T score less than or equal to -2.5 (the World Health Organization definition of osteoporosis). Paget's disease, osteomalacia or any other metabolic bone disease (excluding osteoporosis which is addressed above). Severe diabetes mellitus requiring daily insulin management. Pregnant or interested in becoming pregnant in the next three years. Active infection - systemic or local. Taking medications or any drug known to potentially interfere with bone/soft tissue healing (e.g., steroids). Rheumatoid arthritis or other autoimmune disease. Systemic disease including AIDS, HIV, hepatitis. Active malignancy: A patient with a history of any invasive malignancy (except non-melanoma skin cancer), unless he/she has been treated with curative intent and there have been no clinical signs or symptoms of the malignancy for at least 5 years.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    ProDisc-C

    Control

    Arm Description

    ProDisc-C total disc replacement device intended to treat single level SCDD in the cervical spine from C3-C7

    ACDF

    Outcomes

    Primary Outcome Measures

    Overall Success
    Sponsor Definition of Overall Success: (1) Subject's NDI score improved by at least 20% over preoperative baseline value (2) Subject's neurologic parameters, i.e. motor, sensory, and reflexes were maintained or improved as compared to preoperative baseline value (3) No removals, revisions, re-operations, or additional fixation were required to modify any implant (4) No adverse events occurred which were related to the treatment, ProDisc-C or its implantation or ACDF surgery or its associated implants or graft material

    Secondary Outcome Measures

    Neurologic Success
    % of subjects who were a neurological success (i.e. the patient's neurologic parameters, i.e. motor, sensory, and reflexes are maintained or improved as compared to preoperative baseline value)
    NDI
    NDI is a patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation and is the most commonly used self-report measure for neck pain. The NDI can be scored as a raw score or doubled and expressed as a percent. Each section is scored on a 0-5 rating scale (0='No pain' and 5='Worst imaginable pain'). The points can be summed to a total score. The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage: 0 points or 0% means no activity limitations, 50 points or 100% means complete activity limitation. Mean duration of the test is 3-8 minutes and the results can be interpreted as: 0-4 points (0-8%) no disability; 5-14 points (10-28%) mild disability; 15-24 points (30-48%) moderate disability; 25-34 points (50-64%) severe disability; 35-50 points (70-100%) complete disability
    SF-36 Physical Composite Score (PCS)
    The Short form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight domains, which are both physically and emotionally based. The eight domains that the SF-36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health. A single item is also included that identifies perceived change in health, making the SF-36 a useful indicator for change in QoL over time and treatment. It can take patients at least half an hour to complete the SF-36. The Physical Composite Score (PCS) specifically looks at the mean average of all of the physically relevant questions.
    SF-36 Mental Composite Score (MCS)
    The Short form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight domains, which are both physically and emotionally based. The eight domains that the SF-36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health. A single item is also included that identifies perceived change in health, making the SF-36 a useful indicator for change in QoL over time and treatment. It can take patients at least half an hour to complete the SF-36. The Mental Composite Score (MCS) specifically looks at the mean average of all of the mental or emotional relevant questions.
    VAS Satisfaction
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No Satisfaction [with the surgery/outcome]" at 0mm and "Complete Satisfaction [with the surgery/outcome]" at 100mm.
    VAS Neck Pain Intensity
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No [Neck] Pain" at 0mm and "Worst [Neck] Pain Possible" at 100mm.
    VAS Neck Pain Frequency
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "None of the Time [Neck] Pain" at 0mm and "All of the Time [Neck] Pain" at 100mm.
    VAS Arm Pain Intensity
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No [Arm] Pain" at 0mm and "Worst [Arm] Pain Possible" at 100mm.
    VAS Arm Pain Frequency
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "None of the Time [Arm] Pain" at 0mm and "All of the Time [Arm] Pain" at 100mm.
    Surgery Again
    % of subjects who would opt to have the surgery again if given the choice at 84 months

    Full Information

    First Posted
    February 10, 2006
    Last Updated
    October 17, 2017
    Sponsor
    Synthes USA HQ, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00291018
    Brief Title
    Safety and Efficacy Study Comparing ProDisc-C to ACDF Surgery to Treat SCDD
    Official Title
    A Multi-Center, Prospective, Randomized, Controlled Clinical Trial Comparing the Safety and Effectiveness of ProDisc-C to Anterior Cervical Discectomy and Fusion (ACDF) Surgery in the Treatment of Symptomatic Cervical Disc Disease (SCDD)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2017
    Overall Recruitment Status
    Completed
    Study Start Date
    August 1, 2003 (Actual)
    Primary Completion Date
    March 1, 2015 (Actual)
    Study Completion Date
    March 1, 2015 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Synthes USA HQ, Inc.

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The objective of this clinical investigation is to compare the safety and effectiveness of ProDisc-C to anterior cervical discectomy and fusion (ACDF) surgery in the treatment of symptomatic cervical disc disease (SCDD).

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Symptomatic Cervical Disc Disease
    Keywords
    ProDisc, ProDisc-C, Spinal Fusion, Anterior cervical diskectomy, Cervical spine, Disc disease, Implant, Degenerative disc disease, Intervertebral disc

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    Participant
    Allocation
    Randomized
    Enrollment
    368 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    ProDisc-C
    Arm Type
    Experimental
    Arm Description
    ProDisc-C total disc replacement device intended to treat single level SCDD in the cervical spine from C3-C7
    Arm Title
    Control
    Arm Type
    Active Comparator
    Arm Description
    ACDF
    Intervention Type
    Device
    Intervention Name(s)
    Total Disc Replacement
    Other Intervention Name(s)
    ProDisc-C
    Intervention Description
    Total Disc Replacement using ProDisc-C
    Intervention Type
    Device
    Intervention Name(s)
    ACDF
    Other Intervention Name(s)
    Control
    Intervention Description
    Anterior Cervical Discectomy and Fusion
    Primary Outcome Measure Information:
    Title
    Overall Success
    Description
    Sponsor Definition of Overall Success: (1) Subject's NDI score improved by at least 20% over preoperative baseline value (2) Subject's neurologic parameters, i.e. motor, sensory, and reflexes were maintained or improved as compared to preoperative baseline value (3) No removals, revisions, re-operations, or additional fixation were required to modify any implant (4) No adverse events occurred which were related to the treatment, ProDisc-C or its implantation or ACDF surgery or its associated implants or graft material
    Time Frame
    84 Months
    Secondary Outcome Measure Information:
    Title
    Neurologic Success
    Description
    % of subjects who were a neurological success (i.e. the patient's neurologic parameters, i.e. motor, sensory, and reflexes are maintained or improved as compared to preoperative baseline value)
    Time Frame
    84 months
    Title
    NDI
    Description
    NDI is a patient-completed, condition-specific functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation and is the most commonly used self-report measure for neck pain. The NDI can be scored as a raw score or doubled and expressed as a percent. Each section is scored on a 0-5 rating scale (0='No pain' and 5='Worst imaginable pain'). The points can be summed to a total score. The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage: 0 points or 0% means no activity limitations, 50 points or 100% means complete activity limitation. Mean duration of the test is 3-8 minutes and the results can be interpreted as: 0-4 points (0-8%) no disability; 5-14 points (10-28%) mild disability; 15-24 points (30-48%) moderate disability; 25-34 points (50-64%) severe disability; 35-50 points (70-100%) complete disability
    Time Frame
    84 months
    Title
    SF-36 Physical Composite Score (PCS)
    Description
    The Short form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight domains, which are both physically and emotionally based. The eight domains that the SF-36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health. A single item is also included that identifies perceived change in health, making the SF-36 a useful indicator for change in QoL over time and treatment. It can take patients at least half an hour to complete the SF-36. The Physical Composite Score (PCS) specifically looks at the mean average of all of the physically relevant questions.
    Time Frame
    84 Months
    Title
    SF-36 Mental Composite Score (MCS)
    Description
    The Short form-36 (SF-36) is a 36 item questionnaire which measures Quality of Life (QoL) across eight domains, which are both physically and emotionally based. The eight domains that the SF-36 measures are as follows: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain; general health. A single item is also included that identifies perceived change in health, making the SF-36 a useful indicator for change in QoL over time and treatment. It can take patients at least half an hour to complete the SF-36. The Mental Composite Score (MCS) specifically looks at the mean average of all of the mental or emotional relevant questions.
    Time Frame
    84 Months
    Title
    VAS Satisfaction
    Description
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No Satisfaction [with the surgery/outcome]" at 0mm and "Complete Satisfaction [with the surgery/outcome]" at 100mm.
    Time Frame
    84 Months
    Title
    VAS Neck Pain Intensity
    Description
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No [Neck] Pain" at 0mm and "Worst [Neck] Pain Possible" at 100mm.
    Time Frame
    84 Months
    Title
    VAS Neck Pain Frequency
    Description
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "None of the Time [Neck] Pain" at 0mm and "All of the Time [Neck] Pain" at 100mm.
    Time Frame
    84 Months
    Title
    VAS Arm Pain Intensity
    Description
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "No [Arm] Pain" at 0mm and "Worst [Arm] Pain Possible" at 100mm.
    Time Frame
    84 Months
    Title
    VAS Arm Pain Frequency
    Description
    The Visual Analog Scale (VAS) is a commonly used questionnaire and is presented as a 100mm horizontal line. A patient represents their personal opinion regarding their health by adding a vertical line on the VAS horizontal line between the extremes of "None of the Time [Arm] Pain" at 0mm and "All of the Time [Arm] Pain" at 100mm.
    Time Frame
    84 Months
    Title
    Surgery Again
    Description
    % of subjects who would opt to have the surgery again if given the choice at 84 months
    Time Frame
    84 Months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    60 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Symptomatic cervical disc disease (SCDD) in one vertebral level between C3-C7 defined as: Neck or arm (radicular) pain; and/or a functional/neurological deficit with at least one of the following conditions confirmed by imaging (CT, MRI or X-rays): Herniated nucleus pulposus; Spondylosis (defined by the presence of osteophytes); and/or Loss of disc height. Age between 18 and 60 years. Unresponsive to non-operative treatment for approximately six weeks or has the presence of progressive symptoms or signs of nerve root/spinal cord compression in the face of conservative treatment. NDI score greater than or equal to 15/50 (30%). Psychosocially, mentally and physically able to fully comply with the protocol including adhering to follow-up schedule and requirements and filling out forms. Signed informed consent. Exclusion Criteria: More than one vertebral level requiring treatment. Marked cervical instability on resting lateral or flexion/extension radiographs: translation greater than 3mm and/or greater than 11 degrees of rotational difference to that of either adjacent level. Has a fused level adjacent to the level to be treated. Radiographic confirmation of severe facet joint disease or degeneration. Known allergy to cobalt, chromium, molybdenum, titanium or polyethylene. Clinically comprised vertebral bodies at the affected level(s) due to current or past trauma, e.g. by the radiographic appearance of fracture callus, malunion or nonunion. Prior surgery at the level to be treated. Severe spondylosis at the level to be treated as characterized by any of the following: Bridging osteophytes; A loss of disc height greater than 50%; or Absence of motion (<2°). Neck or arm pain of unknown etiology. Osteoporosis: A screening questionnaire for osteoporosis, SCORE (Simple Calculated Osteoporosis Risk Estimation), will be used to screen patients who require a DEXA (dual energy x-ray absoptiometry) bone mineral density measurement. If DEXA is required, exclusion will be defined as a DEXA bone density measured T score less than or equal to -2.5 (the World Health Organization definition of osteoporosis). Paget's disease, osteomalacia or any other metabolic bone disease (excluding osteoporosis which is addressed above). Severe diabetes mellitus requiring daily insulin management. Pregnant or interested in becoming pregnant in the next three years. Active infection - systemic or local. Taking medications or any drug known to potentially interfere with bone/soft tissue healing (e.g., steroids). Rheumatoid arthritis or other autoimmune disease. Systemic disease including AIDS, HIV, hepatitis. Active malignancy: A patient with a history of any invasive malignancy (except non-melanoma skin cancer), unless he/she has been treated with curative intent and there have been no clinical signs or symptoms of the malignancy for at least 5 years.

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    23138404
    Citation
    Mancuso CA, Cammisa FP, Sama AA, Hughes AP, Girardi FP. Development of an expectations survey for patients undergoing cervical spine surgery. Spine (Phila Pa 1976). 2013 Apr 20;38(9):718-25. doi: 10.1097/BRS.0b013e31827bf204.
    Results Reference
    derived
    PubMed Identifier
    23080427
    Citation
    Zigler JE, Delamarter R, Murrey D, Spivak J, Janssen M. ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single-level cervical symptomatic degenerative disc disease: five-year results of a Food and Drug Administration study. Spine (Phila Pa 1976). 2013 Feb 1;38(3):203-9. doi: 10.1097/BRS.0b013e318278eb38.
    Results Reference
    derived

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    Safety and Efficacy Study Comparing ProDisc-C to ACDF Surgery to Treat SCDD

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