Safety and Efficacy With NOVOCART® Disc Plus (ADCT) for the Treatment of Degenerative Disc Disease in Lumbar Spine (NDisc)

This is an interventional treatment trial for Intervertebral Disc Displacement focused on measuring degenerative disc, herniated disc, sequestrectomy, Autologous Disc Chondrocyte Transplantation, nucleotomy, safety, efficacy, treatment, lumbar spine, low back pain, adjacent degenerative disc, black disc, NOVOCART Read More

Inclusion Criteria:

1. The patient has a disc herniation with back and/or leg pain (radicular pain)
2. The patient has an indication for sequestrectomy according to the guidelines of DGNC and DGOOC
3. The patient is between 18-60 years of age.
4. The patient is physically and mentally able to participate in the study, and is able to understand the study, its goals and the possible risk factors involved. The patient is willing and able to participate in the follow-up visit plan at the study site and is able to understand and to complete study-relevant questionnaires in German language.
5. The patient is sufficiently informed about this trial orally and in writing. S/he had enough time for consideration, is willing to participate in the study and gives her/his written in-formed consent.
6. The patient confirms that s/he did not participate in a clinical study 90 days prior study inclusion. S/he agrees to refrain from participating in another clinical study during the NOVOCART® Disc Study and for another 90 days after study termination

Radiological Inclusion Criteria

Patients must meet all of the following criteria to be considered for enrollment in the NOVO-CART® Disc study.

1. The patient has a single-level lumbar disc herniation
2. The patient has more than 50% remaining disc height in the herniated disc in comparison to unaffected discs in the lumbar spine. If all discs show degenerative signs, disc height has to be at least 5 mm
3. The patient has no obvious signs of osteophytes and no end plate sclerosis in the lumbar segment to be treated with NOVOCART® Disc plus oder NOVOCART® Disc basic

Patients without adjacent degenerative disc (HD):

4. The adjacent proximal disc has no degenerative signs according to Pfirrmann Score stage 3 to 5.

Patients with adjacent degenerative disc (AAD):

4. The patients has additional degenerative signs in the proximal adjacent lumbar level ac-cording to Pfirrmann 3-4, but no more than 25% disc height reduction

Exclusion Criteria:

1. The patient has had a previous surgery at the lumbar level(s) and has been treated with NOVOCART® Disc plus oder NOVOCART® Disc basic.
2. The patient had a past recurrent disc herniation treated with sequestrectomy of the relevant disc.
3. The patient has any degenerative muscular or neurological condition that would interfere with evaluation of outcome measures including but not limited to Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, muscular dystrophy and myelopathic diseases of different causes.
4. BMI > 35 kg/m2
5. The patient has current or recent history of illicit drug, nicotine (more than 20 cigarettes per day) or alcohol abuse or dependence
6. CRP > 10mg/dl

7. The patient is pregnant, breastfeeding or actual planning to become pregnant. Female patients must be either at least two years postmenopausal or using one of the following means of birth control during the treatment phase, i.e. to transplantation

   • surgical sterility
   • double barrier methods, e.g. condom or diaphragm in combination with spermicide
   • intrauterine contraceptive device
   • bilateral vasectomy of sexual partner at least 90 days prior to enrolment in combination with barrier methods (e.g. condom or diaphragm)
   • birth control pill
8. The patient has a history of known allergies or a suspicion of allergies to any of the NO-VOCART® Disc plus oder basic product components including hyaluronan, polyethylenglycol or albumin
9. Immune defects or the affinity for infections of known or unknown causes
10. The patient has a active systemic or local microbial infection, eczematization or inflammable skin alterations at the site of surgery (including Protozoonosis: Babesiosis, Trypanosomiasis (e.g. Chagas-Disease), Leishmaniasis, persistent bacterial infections, like Brucellosis, spotted and typhus fever, other Rickettsiosis, Leprosy, Recurrent Fever, Melioidosis or Tularaemia).
11. The patient is unable to undergo magnetic resonance imaging (MRI)
12. The patient has a history or a suspicion of a disease with chronically inflammable character, as rheumatoid arthritis, gout, pseudo-gout, metabolic bone diseases, Crohn's disease, ulcerative colitis, lupus erythematosus, or other autoimmune disorders
13. Known osteoporosis
14. The patient has a primary hyperparathyroidism or hyperthyroidism, has chronic renal failure or has had previous fragility fractures.
15. Systemic connective tissue or collagen disease
16. Hereditary ocular degenerations with unclear diagnosis, retinopathies based on connective tissue-defined causes, macular corneal dystrophy, (based on the fact that the human cornea expresses cartilage specific proteins as essential functional elements and thus may serve as an indicator for paralleling degenerative events in various cartilaginous tissues)
17. The patient has immune suppression
18. The patient has a history of blood coagulation disease of different genesis, including known haemorrhagic diathesis of unknown cause
19. The patient had undergone chemo or radiotherapy within the past 5 years, or had any cancer other than non-melanoma skin cancer treated with curative intent within the past 5 years
20. Known diabetes, drug treated
21. Ulterior concomitant diseases or functional impairments of specific organs, which exclude study participation by the assessment of the investigator
22. The patient is a prisoner

Radiological Exclusion Criteria

• 1. The patient has apparent degenerative changes in the lumbar spine as determined by Modic Changes 2-3 2. The patient has one or more dysplastic vertebral bodies within the lumbar spine 3. The patient has a sacralised lumbar vertebra LWK5 at the level to be treated with NOVOCART® Disc plus oder NOVOCART® Disc basic 4. The patient has previous or acute spondylodiscitis 5. Segmental instability (spondylolisthesis > 5 mm) or translation > 3 mm 6. The patient has a isthmic spondylolisthesis, ankylosing spondylitis or spondylolysis 7. The patient has lumbar scoliosis (> 11° deformation). 8. The patient has previous trauma, discography or any other surgical intervention at the lumbar spine .

9. The patient has previous compression or burst fracture at the level(s) to be treated with NOVOCART® Disc plus or NOVOCART® Disc basic 10. The patient has a central spinal canal stenosis with evidence of a narrowing of < 8 mm (by MRI, sagittal ) 11. The patient has a spinal tumor 12. The patient has metabolic bone disease 13. The patient has facet ankylosis or severe facet degeneration. 14. The patient has a lumbar kyphosis

Intra-surgery (tissue explant/sequestrectomy) Exclusion Criteria

1. Extensive damage of the Anulus, which subsequently poses a significantly greater risk of recurrence.

Exclusion criteria determined after tissue explant/sequestrectomy

1. HIV infection
2. Treponema pallidum (syphilis) infection
3. active hepatitis B or C infection

Exclusion Criteria prior Transplantation/Implantation

1. Recurrent disc herniation after surgery and prior transplantation/implantation.