MagnetOs Putty Compared to Trinity Evolution in Patients Undergoing up to Four-level Instrumented Posterolateral Fusion

Study Overview
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Brief Summary
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This is a phase IV post-marketing study for MagnetOs Putty. MagnetOs Putty is a synthetic bone graft extender product that is routinely used by surgeons as a treatment for patients with degenerative disc disease and undergoing spinal fusion surgery. In this study, MagnetOs Putty will be used according to the latest U.S. Instructions For Use, specifically as a bone graft extender mixed with autograft in a 1:1 vol.% in the posterolateral spine. Trinity Evolution will also be used according to its latest IFU approved in the US. Specifically, Trinity Evolution is an allograft intended for the treatment of musculoskeletal defects.

Detailed Description
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In this study, following a screening period of a maximum of 30 days, 30 patients will undergo up to four-level instrumented posterolateral fusion (PLF) procedure. Prior to surgery, each patient will be randomized to receive MagnetOs Putty on the assigned side of the spine and Trinity Evolution on the other at the diseased levels. They will be followed up at discharge, Week 2, Week 6, Month 4, Month 6, and Month 12. An interim analysis will be performed once 15 patients have completed their Month 6 visit and have measurements for the endpoints available to measure effectiveness. The primary endpoint will be analyzed at Month 12. In this study, MagnetOs Putty will be applied according to the latest Instructions for Use approved in the United States. Specifically, MagnetOs Putty will be used as a bone graft extender mixed with autograft in a 1:1 vol% in patients with leg pain, and/or back pain requiring up to four-level instrumented posterolateral spine fusion procedure. The fusion procedure (PLF) will be left to the surgeon's discretion. Radiographs will be obtained at Screening, Week 6, Month 4, Month 6 and Month 12. CT-scans will only be obtained at Month 6 and Month 12.

Official Title
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A Prospective, Randomized, Single-center Study to Assess the Performance of MagnEtOsTM Putty Compared to Trinity EvolutionTM in Patients Undergoing up to Four-level Instrumented poSterolatEral Lumbar/Thoraco-lumbar Fusion (PLF)

Conditions
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Degenerative Disc Disease, Spine Fusion, Leg Pain and/or Back Pain

Intervention / Treatment
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* Device: MagnetOs Putty


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient is able to read/be read, understand, and provide written informed consent and has signed the Investigational Review Board (IRB) approved informed consent. Male or female patient ≥ 18 years old. Patients with leg pain, and/or back pain requiring up to four-level instrumented posterolateral lumbar/thoraco-lumbar fusion (T11 - S1) Failed conservative treatment (physical therapy, bed rest, medications, spinal injections, manipulations, or transcutaneous electrical nerve stimulation) for a minimum period of 3 months prior to study enrollment. Exclusion Criteria: Requires > four-level fusion or expected to need secondary intervention within one year following surgery. To treat conditions in which general bone grafting is not advisable. In conditions where the surgical site may be subjected to excessive impact or stresses, including those beyond the load strength of fixation hardware (e.g., defect site stabilization is not possible). In case of significant vascular impairment proximal to the graft site. In case of severe metabolic or systemic bone disorders (e.g., osteogenesis imperfecta or Paget's Disease) that affect bone or wound healing. In case of acute and chronic infections in the operated area (soft tissue infections; inflammation, bacterial bone diseases; osteomyelitis). When intraoperative soft tissue coverage is not planned or possible. Undergoing any procedure that allows MagnetOs to come in direct contact with the articular space. Receiving treatment with medication interfering with calcium metabolism.

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: Parallel Assignment, Intra-patient control. Each patient serves as their own control.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: MagnetOs Putty<br>MagnetOs Putty use in instrumented posterolateral fusion, 7cc-10cc mixed with autograft bone in a 1:1 ratio per spine level at the randomized assigned side | Device: MagnetOs Putty<br>* Procedure: Instrumented Posterolateral Lumbar Fusion<br>|
| Active Comparator: Trinity Evolution<br>Trinity Evolution is a cryopreserved, viable cellular allograft containing cancellous bone and demineralized cortical bone designed for surgical use, applied per spine level at the contralateral side. | Device: MagnetOs Putty<br>* Procedure: Instrumented Posterolateral Lumbar Fusion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Radiographic Fusion by CT Scan | The rate of posterolateral lumbar/thoracolumbar fusion assessed by CT-scan at Month 12. Radiographic as determined by evidence of bridging trabeculae or continuous bony connection between the superior and inferior transverse processes. | Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Radiographic Fusion by Plain Radiographs | The rate of posterolateral lumbar/thoracolumbar fusion assessed by plain radiographs. | Week 2, Week 6, Month 3 | 
| Radiographic Fusion by CT Scan | The rate of posterolateral lumbar/thoracolumbar fusion assessed by CT-scan at Month 6. Radiographic as determined by evidence of bridging trabeculae or continuous bony connection between the superior and inferior transverse processes. | Month 6 | 
| Functional Outcome by Oswestry Disability Index | Functional outcome by the Oswestry Disability Index questionnaire. Patient-completed questionnaire which gives a subjective percentage score of level of function (disability) in activities of daily living. The lower the percentage the higher the patient's functionality. 0-20% minimal disability, 80-100% significant disability. | Week 2, Week 6, Month 3, Month 6, Month 12 | 
| Back and Leg Pain by Visual Analog Pain Scale (VAS) | Change in back and leg pain using Visual Analog Pain Scale score. The patient completed questionnaire is a unidimensional measure of pain intensity using a continuous scale comprised of a horizontal line 10 centimeters (100 mm) in length. The line is anchored by no pain (score of 0) and worst imaginable pain. A higher score indicates greater pain intensity. | Week 2, Week 6, Month 3, Month 6, and Month 12 | 
| Neurologic Status by Physical Exam | Change in neurologic status by examination to document stable, improved, or deficits in condition. Stable or improved findings for lower extremities, specifically reflexes, muscle strength, sensory, and straight leg raise. | Week 2, Week 6, Month 3, Month 6, and Month 12 | 
| Success Rate | Number of patients with secondary surgical interventions (SSI's) such as revisions, re-operations, removals, supplemental fixations, or any other procedure that adjusts or removes part of the original implant configuration with or without replacement of the components within 12 months of surgery. | Week 2, Week 6, Month 3, Month 6, and Month12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Degenerative Disc Disease, Spine Fusion