the kiva® system as a vertebral augmentation treatment

Conditions: Spinal Fractures; Fractures, Compression; Back Injuries

Summary: the purpose of this study is to evaluate the safety and effectiveness of the kiva vcf treatment system in comparison to balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures of the thoracic or lumbar spine.


Eligibility criteria:
inclusion criteria patients must meet all of the following inclusion criteria below to be included as research subjects: 1. the patient is at least 50 years of age 2. the patient has a score on the back pain visual analog scale (vas) of ≥70 mm after 2 to 6 weeks of conservative care or a vas of ≥ 50 mm after 6 weeks of conservative care 3. the patient has an oswestry disability index (odi) score of ≥ 30% 4. the patient has radiographic evidence of one or two (1-2) a 1.1, a 1.2, a 1.3. fractures as classified by the ao spine fracture classification, due to primary or secondary osteoporosis in the thoracic and / or lumbar spine. note that patients are eligible if they have had treatment of or healed vcf(s) at any non-index level 5. the patient has central pain over the spinous process(es) upon palpation at the index level(s) 6. the index fracture(s) is / are acute or persistent (not healed), as demonstrated by t2 weighted stir mri (or bone scan if patient is contraindicated for mri 7. the index fracture(s) has / have failed conservative care of at least 2 weeks but no longer than 6 months 8. the index fracture(s) shows radiographic evidence of at least 5% vertebral collapse 9. the pedicle identified for access to the index fracture has a diameter that is ≥ 6 mm 10. the patient is mentally capable and willing to sign a study-specific informed consent as documentation of the informed consent process prior to any study procedures 11. the patient is willing and able to comply with all study requirements including follow-up visits and radiographic assessments exclusion criteria patients will not be allowed to participate in the study if they meet any of the exclusion criteria below: 1. the index fracture(s) has/have been caused by high-energy trauma 2. the index fracture(s) has / have known tumor involvement 3. the index fracture(s) is/are diagnosed as an osteonecrotic fracture(s) by the treating physician 4. the index fracture(s) is a/are translational force fracture(s) (a2.1, 2.2, 2.3) 5. the index fracture(s) is a/are burst fracture(s) (a 3.3., b or c type) or pedicle fracture(s) with posterior cortical wall disruption 6. the index fracture(s) has / have posterior vertebral wall displacement occupying more than 20% of the cross sectional area of the spinal canal 7. the index fracture(s) has / have severe deformity with reduction of \>75% in any height and accompanying area, using adjacent level as comparison 8. the index level(s) has / have undergone previous surgical treatment for a vertebral body compression fracture or other surgical procedure at the index level(s) 9. angulation of index fracture(s) makes treatment with kiva system impossible (at discretion of surgeon) 10. the pedicle identified for access to the index fracture has a diameter less than 6 mm 11. the patient has paget's disease 12. the patient has a bmi \> 35 13. the patient has uncontrolled diabetes as characterized by hemoglobin hba1c \>7% and/or blood sugar \>180mg/dl 14. the patient has severe cardiopulmonary deficiencies 15. the patient has myelopathy 16. the patient is on long-term steroid therapy (steroid dose ≥ 30 mg /day for \> 3 months) 17. a medical contraindication to spinal surgery and/or general anesthesia, such as coagulopathy (with a threshold for normal being inr ≤ 1.5, ptt within lab normal range, and platelet count \> 100,000) 18. the patient has spinal canal compromise causing clinical manifestations of cord, neural foramen, or nerve root compression at the level(s) to be treated; 19. the patient has neurologic symptoms or deficits or radiculopathy related to the vcf 20. the patient has pain based on clinical diagnosis of herniated nucleus palposus or severe spinal stenosis (progressive weakness or paralysis) 21. the patient has indications of instability related to the index fracture (≥ 30 degrees of kyphosis, translation \>4mm, interspinous process widening, \> grade 1 spondylolisthesis and/or \> 25 degrees of scoliosis if the index level is included in the curve) 22. the patient has planned spine surgery for any disorder during or up to 30 days after the study treatment 23. the patient has had spine surgery for any disorder in the 30 days prior to enrollment 24. the patient has a documented active systemic or local infection, such as osteomyelitis or discitis, with a wbc \> 15.0 x 10\^3/µl and a temperature \> 101.5°f 25. the patient has a known allergy to the investigational device materials and / or acrylics / polymethylmethacrylate (pmma) or a hypersensitivity to monomers 26. the patient has been diagnosed with hemorrhagic diathesis 27. the patient has uncontrolled psychiatric illness or severe dementia 28. the patient has a baseline back pain visual analog scale (vas) of \<50 mm if patient has at least 6 weeks of conservative care or \<70 mm if patient has 2-6 weeks conservative care 29. the patient has a baseline oswestry disability index (odi) score of \<30% 30. the patient is currently on anti-cancer therapy or anti-hiv therapy 31. patient has autoimmune or inflammatory rheumatic disease 32. patient's life expectancy is less than the study duration or undergoing palliative care 33. the patient is known to be a current alcohol or drug abuser 34. the patient is known to be involved in medical litigation including workmen's compensation 35. the patient is a prisoner 36. the patient is participating in another investigational study that has a potential for effect to the study treatment or the study endpoints 37. the patient is pregnant or considering getting pregnant during study participation

Keywords: vertebral compression fracture kyphoplasty spine vertebral body compression fracture back pain