Degenerative Disc Disease
Conditions
Keywords
cervical spine, myelopathy, radiculopathy, cervical spine fusion, circumferential cervical fusion, degenerative disease
Brief summary
This study will evaluate the safety and effectiveness of a device called Posterior Cervical Stabilization System or PCSS when used along with posterior cervical fusion (PCF) in combination with anterior cervical discectomy and fusion (ACDF) in the treatment of multi-level cervical degenerative disease.
Detailed description
Degenerative disc disease (DDD) is a condition in which people experience pain because of compression on the spinal cord or nerve roots caused by degenerating cervical discs. Discs sit between the bones of the spine to provide cushioning, shock absorption, mobility, and load-bearing. When the discs break down, the space between the bones gets smaller and squeezes on the spinal cord or nerve roots causing radiating pain down the neck, shoulders, or arms. A surgical approach to address cervical (neck) DDD is to fuse the bones together to prevent further compression. This can be done with or without removing the disc material itself. The most common way to perform a cervical spinal (neck) fusion to address DDD is to come in from the front of the neck, decompress the spine to relieve pain, and fuse the bones together to prevent further pain in a procedure called Anterior Cervical Discectomy and Fusion (ACDF). Another option is to come in from the back of the neck in a procedure called Posterior Cervical Fusion (PCF). Sometimes these procedures are combined to provide further decompression and stability in the bones of the neck to promote fusion leading to quicker pain relief and return to function.
Interventions
Anterior Cervical Decompression and Fusion (ACDF) is a standard of care procedure that is performed using standard instruments and completed with an allograft interbody implant and anterior plate.
DEVICEPosterior Cervical Stabilization System (PCSS)
Posterior Cervical Stabilization System (PCSS) is non-segmental instrumentation with integrated screw fixation intended to provide immobilization and stabilization of spinal segments. PCSS achieves bilateral facet fixation by spanning the interspace at each level with points of fixation at each end of the construct.
Sponsors
Providence Medical Technology, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Patients will be randomly assigned to either the treatment or control arms at 1:1 ratio.
Intervention model description
prospective, randomized, controlled multi-center trial
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-80 years (Skeletally Mature) 2. Indicated for ACDF treatment of degenerative disc disease (DDD) between and including C3-C7 at 3 contiguous levels 3. NDI Score of ≥15/50 4. Unresponsive to non-operative, conservative treatment (rest, heat, electrotherapy, physical therapy, chiropractic care and/or analgesics) 5. Reported to be medically cleared for surgery 6. Physically and mentally able and willing to comply with the Protocol, including the ability to read and complete required forms and willing and able to adhere to the scheduled follow-up visits and requirements of the Protocol. 7. Written informed consent provided by subject
Exclusion criteria
1. Body Mass Index (BMI) greater than 40 kg/m2 2. Active systemic infection or infection at the operative site 3. History of or anticipated treatment for active systemic infection, including HIV or Hepatitis C 4. Previous trauma to the C3 to C7 levels resulting in significant bony or disco- ligamentous cervical spine injury that may prevent device placements 5. A prior spine surgery or pseudoarthrosis at the operative levels 6. Axial neck pain in the absence of other symptoms of radiculopathy or myeloradiculopathy justifying the need for surgical intervention 7. Symptomatic DDD or significant cervical spondylosis at more than three levels 8. Diagnosis of spondylolisthesis, grade \>2 9. Overt (Segmental) instability measured as a movement on dynamic flex/ext x-rays \>3.5 mm 10. Congenital bony and/or spinal cord abnormalities that affect spinal stability 11. Diagnosis of Paget's disease, osteomalacia or any other metabolic bone disease other than osteoporosis 12. Osteoporosis, defined as either the SCORE or MORES ≥ 6 and a DEXA bone density measured T-score of ≤ -2.5 13. Active malignancy or a history of any invasive malignancy (except non-melanoma skin cancer), unless treated with curative intent and without clinical signs or symptoms of the malignancy for at least five years 14. Has an uncontrolled seizure disorder 15. Use of epidural steroids within 14 days prior to surgery 16. A concomitant condition requiring daily, high-dose oral and/or inhaled steroids 17. Known allergy to titanium (Ti). 18. Fixed or permanent neurologic deficit related to the target treatment levels that cannot be improved with surgical decompression 19. Has, in the Investigator's opinion, any disease or condition that would preclude accurate clinical evaluation (e.g. neuromuscular disorders). 20. Is pregnant or nursing at time of screening, or with plans to become pregnant within the next three years. 21. A current or recent history (≤ 1 year prior to screening) of substance abuse (alcoholism and/or narcotic addiction) that required treatment. 22. Long term use (\>6 months) of opioids (max. daily amount=120 mg morphine equivalents). 23. A mental illness or belongs to a vulnerable population, as determined by the investigator (e.g., prisoner or developmentally disabled), that would compromise ability to provide informed consent or compliance with follow-up requirements. 24. Any other condition or anatomy (e.g. fused facet) that makes posterior fusion treatment infeasible 25. Use of any other investigational drug or medical device within the last 30 days prior to surgery. 26. A pending personal litigation relating to spinal injury (worker's compensation is not exclusionary). 27. Anticipated or potential relocation greater than 50 miles that may interfere with completion of follow-up examinations.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Superiority in Fusion Success in CCF (treatment) compared to ACDF (control) | 12 months | An individual subject is considered a fusion success if there is evidence of bridging trabecular bone across endplates and \< 2° total angular motion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Non-inferiority Composite Safety Success in CCF (treatment) compared to ACDF (control) | 24 months | An individual subject is considered a success if all of the following safety criteria are met: 1. Fusion success - as defined by evidence of bridging trabecular bone across endplates and \< 2° total angular motion 2. Improvement in Neck Disability Index (NDI) 3. Improvement in Neurological function 4. Absence of secondary surgical interventions (SSI) |
Countries
United States
Outcome results
None listed