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出境医 / 临床实验 / Safety Study for An Artificial Disc Replacement to Treat Chronic Low Back Pain

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

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.

Condition or disease Intervention/treatment Phase
Degenerative Disc Disease Chronic Low-back Pain Device: PerQdisc® Nucleus Replacement Device. Not Applicable

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.
Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention 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)
Primary Purpose: Treatment
Official Title: Safety Study for An Artificial Disc Replacement "PerQdisc Nucleus Replacement Device" NUCLEUS 181
Actual Study Start Date : March 1, 2019
Actual Primary Completion Date : May 19, 2021
Actual Study Completion Date : May 19, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: Nucleus Replacement
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.
Device: PerQdisc® Nucleus Replacement Device.
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.

Outcome Measures
Primary Outcome Measures :
  1. Rate of revision surgery at the treated level [ Time Frame: 90 days ]
    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)

  2. Rate of expulsion [ Time Frame: 90 Days ]
    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)

  3. Rate of new herniation at the treated level as determined by MRI [ Time Frame: 90 days ]
    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)

  4. Rate of new radiculopathy [ Time Frame: 90 days ]
    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)

  5. MRI assessment of the endplate Modic changes. [ Time Frame: 90 days ]
    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

  6. Rate of surgical procedure technical success [ Time Frame: 90 days ]
    The number of devices successfully implanted divided by the number of successfully devices implanted + unsuccessful implants. Output will be in percentage (0-100)

  7. Improvement in degree of disability as measured by the Oswestry Disability Index (ODI) [ Time Frame: 90 days ]
    Change in absolute Oswestry Index score at 90 days compared to the preoperative score, range is 0-100

  8. Improvement in back pain as measured by 10-centimeter Visual Analog Scale (VAS) [ Time Frame: 90 days ]
    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.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   22 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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.
Contacts and Locations

Locations
Layout table for location information
Belgium
Onze Lieve Vrouw Ziekenhuis
Aalst, Belgium
Canada, Quebec
Montreal General Hospital
Montreal, Quebec, Canada, H3G 1A4
Croatia
Clinical Hospital Dubrava
Zagreb, Croatia
Germany
Donauisar Klinikum Deggendorf
Deggendorf, Germany, 94469
Sponsors and Collaborators
Spinal Stabilization Technologies
Investigators
Layout table for investigator information
Study Chair: Michael Hess, MD London Spine Clinic/ATOS-Klinik
Tracking Information
First Submitted Date  ICMJE June 26, 2019
First Posted Date  ICMJE July 1, 2019
Last Update Posted Date June 7, 2021
Actual Study Start Date  ICMJE March 1, 2019
Actual Primary Completion Date May 19, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: August 1, 2019)
  • Rate of revision surgery at the treated level [ Time Frame: 90 days ]
    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 [ Time Frame: 90 Days ]
    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 [ Time Frame: 90 days ]
    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 [ Time Frame: 90 days ]
    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. [ Time Frame: 90 days ]
    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 [ Time Frame: 90 days ]
    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) [ Time Frame: 90 days ]
    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) [ Time Frame: 90 days ]
    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.
Original Primary Outcome Measures  ICMJE
 (submitted: June 27, 2019)
  • Rate of revision surgery at the treated level [ Time Frame: 90 days ]
    Composite Endpoint
  • Rate of expulsion [ Time Frame: 90 Days ]
    Composite Endpoint
  • Rate of new herniation at the treated level as determined by MRI [ Time Frame: 90 days ]
    Composite Endpoint
  • Rate of new radiculopathy [ Time Frame: 90 days ]
    Composite Endpoint
  • MRI assessment of the endplate modic changes [ Time Frame: 90 days ]
    Composite Endpoint
  • Rate of surgical procedure technical success [ Time Frame: 90 days ]
    Composite Endpoint
  • Improvement in degree of disability as measured by the Oswestry Disability Index (ODI) composite score. 0-100 scale [ Time Frame: 90 days ]
    Composite Endpoint
  • Improvement in back pain as measured by 10-centimeter Visual Analog Scale (VAS) [ Time Frame: 90 days ]
    Composite Endpoint
Change History
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Safety Study for An Artificial Disc Replacement to Treat Chronic Low Back Pain
Official Title  ICMJE Safety Study for An Artificial Disc Replacement "PerQdisc Nucleus Replacement Device" NUCLEUS 181
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.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Intervention 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)
Primary Purpose: Treatment
Condition  ICMJE
  • Degenerative Disc Disease
  • Chronic Low-back Pain
Intervention  ICMJE Device: PerQdisc® Nucleus Replacement Device.
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.
Study Arms  ICMJE Experimental: Nucleus Replacement
All patients that meet the inclusion/exclusion criteria will receive the PerQdisc® Nucleus Replacement Device.
Intervention: Device: PerQdisc® Nucleus Replacement Device.
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Terminated
Actual Enrollment  ICMJE
 (submitted: June 3, 2021)
9
Original Estimated Enrollment  ICMJE
 (submitted: June 27, 2019)
34
Actual Study Completion Date  ICMJE May 19, 2021
Actual Primary Completion Date May 19, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

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.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 22 Years to 60 Years   (Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Belgium,   Canada,   Croatia,   Germany
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04004156
Other Study ID Numbers  ICMJE N181
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Spinal Stabilization Technologies
Study Sponsor  ICMJE Spinal Stabilization Technologies
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Study Chair: Michael Hess, MD London Spine Clinic/ATOS-Klinik
PRS Account Spinal Stabilization Technologies
Verification Date March 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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