Comparison of Bioactive Glass Ceramics Spacer and PEEK Cages in Posterior Lumbar Interbody Fusion: A Prospective, RCT

Study Overview
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Brief Summary
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The authors aimed to compare the clinical efficacy and safety of CaO-SiO2-P2O5-B2O3 glass ceramics with PEEK cage that is widely used for posterior lumbar interbody fusion (PLIF) surgery in the clinical field.

Official Title
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Comparison of Fusion Rate and Clinical Results Between Bioactive Glass Ceramics Spacer With PEEK Cages in Posterior Lumbar Interbody Fusion: A Prospective, Randomized Controlled Non-inferiority Trial

Conditions
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Degenerative Lumbar Spinal Stenosis

Intervention / Treatment
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* Device: NovoMax, BioAlpha Inc, Seong-nam, Korea
* Device: PEEK cage


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients aged between 30 and 80 patients who required one-level PLIF between L1 and S1 among those who required an extensive laminectomy or facetectomy to correct severe disc extrusion or severe spinal stenosis or those who required PLIF due to grade I or II spondylolisthesis those who (only if a signature was obtainable), or whose legal guardian, fully understood the clinical trial details and signed the informed consent form. Exclusion Criteria: osteoporosis patients with average T-scores of L1-L4 at <-3.0 in DEXA bone density tests women with positive pregnancy tests before the trial or who planned to become pregnant within the following 3 years patients with a history of malignant tumor or malignant diseases (but the cases of cured disease with no relapse for the past 5 years were included in the present study) patients with abnormal blood potassium and phosphorus levels; patients with liver disease, kidney disease, respiratory disease, metabolic disease, or psychological disease; patients deemed to have less than 1-year life expectancy; patients with mental retardation or whose parents or legal guardians were older or had mental disabilities; other patients viewed as inappropriate by the staff

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Novomax<br>Novomax(R) ceramic glass spacer for interbody fusion | Device: NovoMax, BioAlpha Inc, Seong-nam, Korea<br>* CaO-SiO2-P2O5-B2O3 glass ceramics spacer<br>|
| Active Comparator: PEEK cage<br>PEEK cage for interbody fusion | Device: PEEK cage<br>* PEEK cage<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fusion rates | This is assessed by postoperative computed tomography at 1 year after surgery | up to 5 year after operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Pain Scale (VAS) | VAS is a measurement score that indicates pain severity status. VAS score comprised a 10-cm line with ''none'' (0) on one end of the scale and ''disabling pain'' (10) on the other. | 3, 6, and 12, months, and every year, up to 5 year after operation | 
| Oswestry Disability Index (ODI) | The ODI is based on a self-administered questionnaire measuring ''back-specific function.'' The questionnaire comprises 10 items, each with 6 levels of response. Each item is scored from 0 to 5, and the total summation is converted to a 0-100 scale.20 The ODI scores ranges from 0 to 100, with higher scores indicating severe symptoms. | 3, 6, and 12, months, and every year, up to 5 year after operation | 
| EQ-5D | EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life that can be used in a wide range of health conditions and treatments. The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. This can be used as a quantitative measure of health outcome that reflects the patient's own judgement. The scores on these five dimensions can be presented as a health profile or can be converted to a single summary index number (utility) reflecting preferability compared to other health profiles. | 3, 6, and 12, months, and every year, up to 5 year after operation | 
| PainDETECT | The painDETECT Questionnaire (PDQ) is a screening tool designed to detect neuropathic pain in patients with chronic low back pain (LBP) based on self-reported pain characteristics. The degree of the seven types of pain quality, the type of pain pattern, and the presence of radiating pain. From the three components of the PDQ, a total score is calculated; a high score indicates that the pain is likely to have a neuropathic component. Scoring is performed using a scoring manual, and results in a final screening score: a score of 0-12 indicates nociceptive pain, 19-38 indicates neuropathic pain, and 13-18 indicates mixed pain. | 3, 6, and 12, months, and every year, up to 5 year after operation | 
| Fusion rates | This is assessed by postoperative simple radiography at 1 year after surgery | every year, up to 5 year after operation | 
| Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 | Device related adverse events (fracture, translation, subsidence, osteolysis), Surgery related adverse events (incidental durotomy, wound infection, re-operation, re-admission) | every year, up to 5 year after operation |