RHINE™ Cervical Disc Clinical Study: A Prospective Observational Study for Patients Requiring 1-2 Level C-spine Surgery

A Prospective, open label, multi-center observational study of patients requiring surgical treatment at one or two (contiguous) cervical spine levels. The primary objectives of the RHINE Cervical Disc study are to: obtain operative data and feedback on surgical instruments and surgical technique; confirm device performance in terms of clinical and radiographic outcomes; confirm device performance in terms of safety and to collect original data to be compared to published reports of the performance of comparable motion-sparing devices, as well as clinical outcomes of fusion devices.

A Prospective, open label, multi-center observational study of patients requiring surgical treatment at one or two (contiguous) cervical spine levels ( C3-C7). The primary objectives of the RHINE Cervical Disc study are to: obtain operative data and feedback on surgical instruments and surgical technique; confirm device performance in terms of clinical and radiographic outcomes; confirm device performance in terms of safety and to collect original data to be compared to published reports of the performance of comparable motion-sparing devices, as well as clinical outcomes of fusion devices. Device- and procedure-related adverse events, serious adverse events, and secondary surgeries will be monitored throughout. AEs will be characterized by severity, seriousness and relationship to device. Investigator reports of serious adverse events and any AE trends will be reviewed by a medical monitor.

Eligibility Criteria:
Inclusion Criteria:

* The patient requires reconstruction of the disc from C3 to C7 following discectomy at 1 or 2 (contiguous) levels for intractable radiculopathy (arm pain and/or a neurological deficit) with or without neck pain, or myelopathy due to abnormality localized to the level of the disc space and at least one of the following conditions confirmed by radiographic imaging (CT, MRI, X-rays): herniated nucleus pulposus, spondylosis (defined by the presence of osteophytes), and/or visible loss of disc height compared to adjacent levels.
* The patient has failed at least 6 weeks of non-operative treatment or demonstrated progressive signs or symptoms despite non-operative treatment prior to implantation.
* Self-reports a pre-operative upper extremity (right or left) VAS pain score ≥ 20 (0-100).
* Self-reports pre-operative NDI score ≥ 30% (raw score of ≥ 15/50).
* Willing and able to comply with the protocol requirements including follow-up visit schedule.
* Willing and able to sign a study specific informed consent.

Exclusion Criteria:

* More than two cervical levels requiring surgery, or has two levels requiring surgery that are not adjacent.
* Previous surgical intervention at the target level(s)
* Any of the following at the target level(s):
* Significant cervical anatomical deformity, e.g., ankylosing spondylitis, rheumatoid arthritis, etc.
* Moderate to advanced spondylosis. Patients who demonstrate advanced degenerative changes characterized by any of the following: bridging osteophytes, marked reduction or absence of motion (\< 2 degrees change from flexion to extension), collapse of the intervertebral disc space of greater than 50% of its normal height (compared to adjacent levels)
* Radiographic signs of subluxation \> 3.5 mm
* Angulation of the disc space more than 11 degrees greater than adjacent segments
* Significant kyphotic deformity (\> 5 degrees) at a single level or significant reversal of lordosis (not corrected with extension)
* Fused level adjacent to a level to be treated
* Axial neck pain is the patient's solitary symptom
* Severe pathology of the facet joints of the involved vertebral bodies
* Previous diagnosis of osteopenia or osteomalacia
* Has any of the following risk factors that may be associated with a diagnosis of osteoporosis.
* Spinal metastases
* Extreme obesity (BMI ≥ 40)
* Overt or active bacterial infection, either local or systemic
* Severe insulin dependent diabetes
* Chronic or acute renal failure or prior history of renal disease
* Fever (temp \> 38.3° C oral) at the time of surgery
* Documented allergy or intolerance to titanium or polyurethane
* Reported concomitant conditions requiring daily, high-dose oral and/or inhaled steroids.
* Any medical condition that may interfere with the postoperative management program or preclude meaningful patient self-assessments, e.g., advanced emphysema, progressive neurological disease, or Alzheimer's disease
* Any medical condition that may result in patient death prior to study completion, e.g., unstable cardiac disease, active malignancy
* History of an endocrine or metabolic disorder known to affect osteogenesis
* Active immunosuppressive disorder that may predispose patient to infection
* Participating in or planning to participate in another clinical study that might influence the treatment outcomes or ability to comply with the study requirements
* Member of a vulnerable population such as, mentally incompetent, prisoner
* Pregnant, nursing, considering becoming pregnant during the study, or is of childbearing potential and unwilling to use an accepted form of birth control during the study.
* History or suspicion of substance abuse or currently undergoing substance abuse treatment
* In the judgment of the Investigator, patient is not likely to be able to fulfill the requirements of the study.