Osteopenia, Osteoporosis, Multiple Myeloma, Bone Neoplasms
Conditions
Keywords
Osteopenia, Osteoporosis, Multiple Myeloma, Osteolytic Metastatic Tumors, Vertebral Compression Fracture, Back Pain, Spine
Brief summary
The primary objective of this study is to compare the effectiveness of standard medical therapy alone to kyphoplasty using the KyphX system for the treatment of acute vertebral body compression fractures.
Interventions
DEVICEBalloon Kyphoplasty
Sponsors
Medtronic Spine LLC
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Minimum of one painful, acute (edema present on MRI obtained within a two weeks period prior to enrolment) thoracic or lumbar (T5-L5) vertebral body compression fracture, due to osteopenia arising from primary or secondary osteoporosis, multiple myeloma, or osteolytic metastatic tumors and maximum of three painful fractures requiring treatment. (NOTE: a T2-weighted MRI should be done unless it is not available); * Minimum of one acute fracture to be treated that has height loss \> 15% of predicted height (average height of two adjacent normal vertebrae) when measured at the middle of the vertebral endplate. (NOTE: If the adjacent vertebrae are not normal, the predicted height will be based on the height listed for the fractured vertebra in the table taken from Black et al.) * Pre-treatment VAS score \> 4 on a scale of 10 where 0 is no pain, 5 is moderate pain and 10 is pain as bad as you can imagine; * Patient 21 years of age or older; * The investigator and surgeon/radiologist agree before randomization that the fracture(s) can technically be reduced using an inflatable bone tamp (IBT); and * A signed Informed Consent is obtained from the patient.
Exclusion criteria
* Previous vertebroplasty; * Vertebral body fracture morphology prevents use of devices (such as endplate below pedicles); * Pedicle fractures; * Acute fracture(s) to be treated symptomatic \> 3 months at enrollment; * Pre-existing (not the result of the index fracture) neurological deficit or radicular pain that is not well defined or unstable; * Spinal cord compression or canal compromise requiring decompression; * Disabling back pain secondary to causes other than acute fracture; * Vertebral fracture due to primary or osteoblastic tumors; * Patient is currently on anticoagulation therapy that can not be interrupted; * Pre-existing conditions contrary to the kyphoplasty procedure: * Systemic infection * Local fractured vertebral body infection * Temporarily non-reversible bleeding disorder * Known allergy to any of the drugs, bone void filler material or contrast medium used in the treatment of study subjects * Dementia and/or inability to give informed consent; * Inability to walk or stand prior to the vertebral body fracture (walking aids are allowed); * MRI contraindication (e.g. cerebral aneurysm clips, pacemaker, implanted biostimulators, cochlear implants, penile prosthesis); * Pregnancy * Participation in any other clinical trial within the last 30 days.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary objective of this study is to compare the effectiveness of standard medical therapy alone to kyphoplasty using the KyphX system for the treatment of acute vertebral compression fractures (VCFs). | — |
| Safety will be compared between the study groups throughout the study with focus on clinically meaningful events and subsequent VCFs including the treated vertebrae. | — |
| The primary study endpoint is the change in quality of life as measured by the Physical Component Summary (PCS) scale of the 36-Item Short Form (SF-36) as measured at the one-month follow-up visit. | — |
Secondary
| Measure | Time frame |
|---|---|
| pain using a 10-point visual analogue scale (VAS) at 5-10 days (post enrollment for the control group and post kyphoplasty for the kyphoplasty group) | — |
| changes in spinal deformity as measured radiographically at baseline, 3, 12 and 24 months. | — |
| Maintenance of vertebral body height will be assessed from lateral spine x-rays obtained in Kyphoplasty treated subjects only at baseline and at 3, 12, and 24 month visits. | — |
| patient satisfaction at 1, 3, 6, 12, 24 months | — |
| The secondary study endpoints are: EuroQol self-report (EQ-5D) questionnaire and SF-36 scores at 1, 3, 6, 12 and 24 months | — |
| economic aspects (including hospital days, disabilities, etc.) at 1, 3, 6, 12, 24 months | — |
| the cost-effectiveness of kyphoplasty expressed in incremental cost/quality adjusted life year gained at different time points (1 year and 2 years) | — |
| rate of incident fractures at 3, 12 and 24 months (frequency, timing and location) | — |
| Each endpoint will be compared between the 2 groups and for its evolution over time. | — |
| outcome (nursing home, back to status prior to fracture) at 1, 3, 6, 12, 24 months | — |
| procedural safety (peri-operative clinical events) | — |
| function as measured by objective functionality tests-reaching, get up and go and by the subjective Roland Morris disability questionnaire at 1, 3, 6, 12 and 24 months | — |
Countries
United States
Outcome results
None listed