Actifuse ABX Versus INFUSE in Posterolateral Instrumented Lumbar Fusion

This is a prospective randomised study.

Primary objective: Evaluation of success rates of Actifuse ABX and INFUSE in achieving bone fusion.

Secondary objectives: Assess clinical outcome measurements.


Eligibility Criteria:
Inclusion Criteria:

* Have degenerative disc disease of the lumbar spine as indicated by back pain of discogenic/degenerative origin with or without leg pain and has one or more of the following conditions as documented by Plain X-Rays, CT Scan or MRI Scan:

  * Modic changes.
  * High intensity changes in the annulus.
  * Loss of disc height.
  * Decreased hydration of the disc.
  * Canal stenosis with or without Spondylotic slip.
  * Gross facet joint changes requiring fusion for treatment.
  * Have documented annular pathology by other means. (e.g. with discography).
* Have a preoperative Oswestry Back Disability Score of 30 or more.
* Aged 18 to 75 years and skeletally mature at time of surgery.
* Have not responded to non-operative treatment (e.g. bed rest, physical therapy, medications and/or spinal injections) for a period of six months.
* If of childbearing potential, patient is non-pregnant, non-nursing and agrees not to become pregnant for one year following surgery.
* Is will to and able to comply with the study plan and able to understand and sign the Patient Informed Consent Form.

Exclusion Criteria:

* Has had previous failed attempts at fusion surgery at the involved level(s).
* Has a diagnosis of spinal infection tumour or trauma.
* Requires surgery at more than two (2) levels.
* Has osteoporosis (excluding osteopenia) as evidenced on plain X-rays, CT Scans (or DEXA scan in cases of doubt).
* Is pregnant.
* Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse.
* Has received drugs that may interfere with bone metabolism within two weeks prior to the planned surgery date (e.g. steroids or methotrexate) excluding routine perioperative, non-steroidal anti-inflammatory drugs.
* Has a history of autoimmune disease.
* Has a history of exposure to injectable collagen implants.
* Has a history of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen.
* Has received treatment with an investigational therapy (device and/or pharmaceutical) within 30 days prior to surgery or such treatment is planned during the 24 months following surgery.
* Has received any previous exposure to any/all BMPs of either human or animal extraction.
* Has a history of allergy to bovine products or a history of anaphylaxis.
* Has a history of any endocrine or metabolic disorder known to affect osteogenesis (e.g. Paget's disease, renal oseodystrophy, Ehlos-Danlos syndrome or Osteogenesis Imperfecta).
* Has any disease that would preclude accurate clinical evaluation (e.g. neuromuscular disease etc).
* Has a primary diagnosis of a spinal disorder other than degenerative disc disease or other conditions as set out in "Inclusions" above at the involved level(s).
* Has a condition that requires postoperative medications that interfere with fusion, such as steroids or prolonged use of non-steroidal anti-inflammatory drugs, excluding routine perioperative, non-steroidal anti-inflammatory drugs. This does not include low dose aspirin for prophylactic anticoagulation.
* Has overt or active bacterial infection, local or systemic and/or a potential for bacteremia.
* Has presence of active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin).
* Has a documented metal allergy or intolerance to titanium alloy or cobalt-chrome-molybdenum alloy.
* Who, in the opinion of the Principal Investigator or Co-Investigators, is intellectually unable to co-operate with the study.
* Has chronic or acute renal and/or hepatic failure or prior history of renal or hepatic disease.