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Safety Study for An Artificial Disc Replacement to Treat Chronic Low Back Pain

Primary Purpose

Degenerative Disc Disease, Chronic Low-back Pain

Status
Unknown status
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
PerQdisc® Nucleus Replacement Device.
Sponsored by
Spinal Stabilization Technologies
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Degenerative Disc Disease focused on measuring Degenerative Disc Disease, DDD, Chronic Low-back Pain, Low Back Pain, Nucleus Replacement Device, Nucleus Pulposus, Disc Replacement, Back pain, Leg pain, Lumbar Spinal Fusion

Eligibility Criteria

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

Inclusion Criteria:

  • Patient is skeletally mature and between 22 and 60 years of age.
  • Patient has degenerative disc disease (DDD) at a single level between L1 and S1 as confirmed by:History and clinical findings suggestive of symptomatic DDD, Darkened disc on MRI in T2 weighted images, and decreased disc height (decreased greater than 2 mm compared to adjacent cranial or caudal disc height) with minimum disc height of 6 mm.
  • Patient has pre-operative back pain VAS score of greater than or equal to 4 (0-10 scale).
  • Patient has pre-operative Oswestry Low Back Disability score of greater than or equal to 40 (0-100 scale).
  • Patient has received conservative (non-surgical) treatment for back pain for a minimum of 6 months.
  • Patient has signed the approved Informed Consent Form.

Exclusion Criteria:

  • Patient has had prior lumbar spine surgery.
  • Patient has motion of less than 3 degrees on pre-operative lateral flexion/extension radiographs.
  • Patient has ankylosing spondylitis or other spondyloarthropathy.
  • Patient has isthmic spondylolisthesis or degenerative spondylolisthesis greater than 2 mm.
  • Patient has congenital stenosis or epidural lipomatosis.
  • Patient has significant facet disease.
  • Patient has any known active malignancy.
  • Patient has previously undergone immunosuppressive therapy.
  • Patient has active local or system infection.
  • Patient has been diagnosed with hepatitis, rheumatoid arthritis, lupus erythematosus, or other autoimmune disease, including AIDS, ARC and HIV
  • Patient has diabetes mellitus (Type 1 or 2), requiring daily insulin management.
  • Patient has osteopenia of the spine (T-score less than 1.0). All females 45 years of age or older and all males 50 or older should have a DEXA scan to confirm this exclusion.
  • Patient has morbid obesity defined as body mass index (BMI) more than 40 or a weight of more than 45 kg (100 lbs) over ideal body weight.
  • Patient is pregnant or plans to become pregnant during the course of the study.
  • Patient has a known allergy to silicone (polymer and balloon material) or barium sulfate (polymer).
  • Patient participated in another investigational drug or device study within the past 30 days.
  • Patient belongs to a vulnerable population or has a condition such that his/her ability to provide informed consent, comply with follow-up requirements, or provide self assessments is compromised (e.g. developmentally disables, prisoner, chronic alcohol/ substance abuser)
  • Patient has a disc herniation
  • Patient has a Schmorl's node in the level to be treated

Intraoperative exclusion criteria:

  • Protrusion of the 20A imaging balloon up to or beyond the outer margin of the vertebra during the imaging steps.
  • Patient has a violated endplate.
  • Patient has a disc space that is too narrow.

Sites / Locations

  • Onze Lieve Vrouw Ziekenhuis
  • Montreal General Hospital
  • Clinical Hospital Dubrava
  • Donauisar Klinikum Deggendorf

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Nucleus Replacement

Arm Description

All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.

Outcomes

Primary Outcome Measures

Rate of revision surgery at the treated level
Number of patients requiring surgeries to revise the implanted level in the spine divided by the total number of implant surgeries. Express in percentage (0-100)
Rate of expulsion
The rate of device expulsion. The number of patients determined to have expulsed devices divided by the total number of patients receiving implants.Expressed in percentage (0-100)
Rate of new herniation at the treated level as determined by MRI
Herniation will be determine by MRI. A herniation will be defined as violation of the intervertebral annulus, including expulsion of nucleus material. The response will be yes/no as assessed by the radiologist. Rate will be determined by total number of herniations divided by the total number of implanted devices. Expressed in percentage (0-100)
Rate of new radiculopathy
New complaint of leg pain will be recorded as a yes/no response. Any complaint of new radiculopathy not seen preoperatively. Expressed as total number of new radiculopathy complaints divided by total number of patients. Expressed in percentage (0-100)
MRI assessment of the endplate Modic changes.
Changes to vertebral endplates will be assigned based on Modic classification of I,II or III comparing preoperative grade to grade at 90 days. Possible scores are I,II or III
Rate of surgical procedure technical success
The number of devices successfully implanted divided by the number of successfully devices implanted + unsuccessful implants. Output will be in percentage (0-100)
Improvement in degree of disability as measured by the Oswestry Disability Index (ODI)
Change in absolute Oswestry Index score at 90 days compared to the preoperative score, range is 0-100
Improvement in back pain as measured by 10-centimeter Visual Analog Scale (VAS)
Change in the Visual Analogue Scale (VAS) for back and leg pain on a scale of 0-10 cm comparing preoperative scores to 90 days post-operative.

Secondary Outcome Measures

Full Information

First Posted
June 26, 2019
Last Updated
July 13, 2021
Sponsor
Spinal Stabilization Technologies
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1. Study Identification

Unique Protocol Identification Number
NCT04004156
Brief Title
Safety Study for An Artificial Disc Replacement to Treat Chronic Low Back Pain
Official Title
Safety Study for An Artificial Disc Replacement "PerQdisc Nucleus Replacement Device" NUCLEUS 181
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Unknown status
Study Start Date
March 1, 2019 (Actual)
Primary Completion Date
January 31, 2022 (Anticipated)
Study Completion Date
June 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Spinal Stabilization Technologies

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
This study will be a prospective, open-label, multi-center study that will collect safety data for the minimally invasive PerQdisc Nucleus Replacement Device deployed to reduce chronic low back pain.
Detailed Description
This study will be a prospective, open-label, multi-center study that will collect safety data for the minimally invasive PerQdisc Nucleus Replacement Device (NRD). The NRD is used for surgical replacement of a single nucleus pulposus between spinal lumbar discs L1-S1 using an anterior or lateral transpsoas approach. Currently the surgical gold standard involves spinal fusion of the affected vertebral bodies, reducing range of motion and increasing stress on other vertebral bodies. The goal of nucleus replacement is to reduce chronic low back pain by maintaining disc height while preserving range of motion.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Degenerative Disc Disease, Chronic Low-back Pain
Keywords
Degenerative Disc Disease, DDD, Chronic Low-back Pain, Low Back Pain, Nucleus Replacement Device, Nucleus Pulposus, Disc Replacement, Back pain, Leg pain, Lumbar Spinal Fusion

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
This is an open label study. Patients that are unable to receive an implant due to intraoperative exclusion will receive standard of care
Masking
None (Open Label)
Allocation
N/A
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nucleus Replacement
Arm Type
Experimental
Arm Description
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.
Intervention Type
Device
Intervention Name(s)
PerQdisc® Nucleus Replacement Device.
Intervention Description
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.
Primary Outcome Measure Information:
Title
Rate of revision surgery at the treated level
Description
Number of patients requiring surgeries to revise the implanted level in the spine divided by the total number of implant surgeries. Express in percentage (0-100)
Time Frame
90 days
Title
Rate of expulsion
Description
The rate of device expulsion. The number of patients determined to have expulsed devices divided by the total number of patients receiving implants.Expressed in percentage (0-100)
Time Frame
90 Days
Title
Rate of new herniation at the treated level as determined by MRI
Description
Herniation will be determine by MRI. A herniation will be defined as violation of the intervertebral annulus, including expulsion of nucleus material. The response will be yes/no as assessed by the radiologist. Rate will be determined by total number of herniations divided by the total number of implanted devices. Expressed in percentage (0-100)
Time Frame
90 days
Title
Rate of new radiculopathy
Description
New complaint of leg pain will be recorded as a yes/no response. Any complaint of new radiculopathy not seen preoperatively. Expressed as total number of new radiculopathy complaints divided by total number of patients. Expressed in percentage (0-100)
Time Frame
90 days
Title
MRI assessment of the endplate Modic changes.
Description
Changes to vertebral endplates will be assigned based on Modic classification of I,II or III comparing preoperative grade to grade at 90 days. Possible scores are I,II or III
Time Frame
90 days
Title
Rate of surgical procedure technical success
Description
The number of devices successfully implanted divided by the number of successfully devices implanted + unsuccessful implants. Output will be in percentage (0-100)
Time Frame
90 days
Title
Improvement in degree of disability as measured by the Oswestry Disability Index (ODI)
Description
Change in absolute Oswestry Index score at 90 days compared to the preoperative score, range is 0-100
Time Frame
90 days
Title
Improvement in back pain as measured by 10-centimeter Visual Analog Scale (VAS)
Description
Change in the Visual Analogue Scale (VAS) for back and leg pain on a scale of 0-10 cm comparing preoperative scores to 90 days post-operative.
Time Frame
90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is skeletally mature and between 22 and 60 years of age. Patient has degenerative disc disease (DDD) at a single level between L1 and S1 as confirmed by:History and clinical findings suggestive of symptomatic DDD, Darkened disc on MRI in T2 weighted images, and decreased disc height (decreased greater than 2 mm compared to adjacent cranial or caudal disc height) with minimum disc height of 6 mm. Patient has pre-operative back pain VAS score of greater than or equal to 4 (0-10 scale). Patient has pre-operative Oswestry Low Back Disability score of greater than or equal to 40 (0-100 scale). Patient has received conservative (non-surgical) treatment for back pain for a minimum of 6 months. Patient has signed the approved Informed Consent Form. Exclusion Criteria: Patient has had prior lumbar spine surgery. Patient has motion of less than 3 degrees on pre-operative lateral flexion/extension radiographs. Patient has ankylosing spondylitis or other spondyloarthropathy. Patient has isthmic spondylolisthesis or degenerative spondylolisthesis greater than 2 mm. Patient has congenital stenosis or epidural lipomatosis. Patient has significant facet disease. Patient has any known active malignancy. Patient has previously undergone immunosuppressive therapy. Patient has active local or system infection. Patient has been diagnosed with hepatitis, rheumatoid arthritis, lupus erythematosus, or other autoimmune disease, including AIDS, ARC and HIV Patient has diabetes mellitus (Type 1 or 2), requiring daily insulin management. Patient has osteopenia of the spine (T-score less than 1.0). All females 45 years of age or older and all males 50 or older should have a DEXA scan to confirm this exclusion. Patient has morbid obesity defined as body mass index (BMI) more than 40 or a weight of more than 45 kg (100 lbs) over ideal body weight. Patient is pregnant or plans to become pregnant during the course of the study. Patient has a known allergy to silicone (polymer and balloon material) or barium sulfate (polymer). Patient participated in another investigational drug or device study within the past 30 days. Patient belongs to a vulnerable population or has a condition such that his/her ability to provide informed consent, comply with follow-up requirements, or provide self assessments is compromised (e.g. developmentally disables, prisoner, chronic alcohol/ substance abuser) Patient has a disc herniation Patient has a Schmorl's node in the level to be treated Intraoperative exclusion criteria: Protrusion of the 20A imaging balloon up to or beyond the outer margin of the vertebra during the imaging steps. Patient has a violated endplate. Patient has a disc space that is too narrow.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Hess, MD
Organizational Affiliation
London Spine Clinic/ATOS-Klinik
Official's Role
Study Chair
Facility Information:
Facility Name
Onze Lieve Vrouw Ziekenhuis
City
Aalst
Country
Belgium
Facility Name
Montreal General Hospital
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3G 1A4
Country
Canada
Facility Name
Clinical Hospital Dubrava
City
Zagreb
Country
Croatia
Facility Name
Donauisar Klinikum Deggendorf
City
Deggendorf
ZIP/Postal Code
94469
Country
Germany

12. IPD Sharing Statement

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Safety Study for An Artificial Disc Replacement to Treat Chronic Low Back Pain

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