Osteocel® Plus in eXtreme Lateral Interbody Fusion (XLIF®)

Osteocel® Plus in eXtreme Lateral Interbody Fusion (XLIF®): Evaluation of Radiographic and Patient Outcomes

This is a prospective, non-randomized multi-center study to compare the use of Osteocel® Plus in subjects who receive XLIF® (eXtreme Lateral Interbody Fusion) surgery at one or two levels. These subjects will present with degenerative conditions in the lumbar spine that are amenable to surgical treatment and will be screened prior to study enrollment. Subjects will receive Osteocel Plus during their XLIF operation. Subjects will be followed for 24-months following surgery to determine the number of study subjects that are solidly fused at or before 24 months postoperatively, and to determine the mean time to fusion. This data will be compared to published and/or retrospective data for autograft, synthetic ceramics and Bone Morphogenetic Protein (BMP).

Study Overview

• Status: Completed
• Conditions: Back Pain; Degenerative Disc Disease
• Intervention / Treatment: Biological: biologic, Osteocel Plus

Detailed Description

Osteocel Plus is an allograft cellular bone matrix containing native mesenchymal stem cells (MSCs) which is intended to mimic the biologic performance of autograft without the morbidity associated with the autograft harvest. Mesenchymal stem cells, like those found in Osteocel Plus, are naturally occurring in the body and can differentiate into a variety of tissue types, depending on the local environment. Once implanted, MSCs can differentiate into osteoblasts, which produce new bone matrix. MSCs also naturally secrete bone-inducing growth factors that signal the patient's endogenous cells to migrate and participate in the bone formation process. Osteocel Plus is different from other orthobiologic products such as DBM and allograft cancellous bone because it contains living stem cells, which provide osteogenic potential. The cells include mesenchymal stem cells from an adult human donor; they are not from an embryonic source.

This study is being conducted to determine the percentage of patients with solid spinal fusions after being treated with Osteocel in an XLIF procedure. Due to the unique processing conditions, Osteocel Plus retains a high concentration of stem cells in conjunction with the allograft bone matrix, so it is hypothesized that the fusion rate with Osteocel Plus will be comparable to published data for autograft. The Osteocel product family has already been used in approximately 15,000 cases worldwide.

• Study Type: Observational
• Enrollment (Actual): 104

Contacts and Locations

Study Locations

• United States
  • California
    • La Jolla, California, United States, 92037
      • Shiley Center for Orthopaedic, Scripps Green Hospital
  • Florida
    • Hollywood, Florida, United States, 33021
      • Broward Spine Institute
    • Miami Beach, Florida, United States, 33140
      • South Florida Spine Institute, Mount Sinai Medical Center
    • Sarasota, Florida, United States, 34232
      • Southeastern Spine Center, Doctors Hospital of Sarasota
    • Tampa, Florida, United States, 33606
      • USF, Tampa General Hospital
  • Georgia
    • Marietta, Georgia, United States, 30060
      • Pinnacle Orthopaedics, Wellstone Kennestone Hospital
  • Illinois
    • Naperville, Illinois, United States, 60540
      • The Spine Center of DuPage Medical Group, Edward Hospital
  • Indiana
    • Indianapolis, Indiana, United States, 46219
      • Indiana Center for Neurosurgery
  • Missouri
    • Columbia, Missouri, United States, 65205
      • Columbia Orthopaedic Group, Boone Hospital Center
    • Jefferson City, Missouri, United States, 65101
      • Spine Midwest, St. Mary's Health Center
  • Nevada
    • Las Vegas, Nevada, United States, 89109
      • Western Regional Center for Brain & Spine Surgery, Surgery Center of S. Nevada
  • New York
    • Lockport, New York, United States, 14094
      • Buffalo Spine Surgery, Kenmore Mercy
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27710
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Existing clinic patients

Description

Inclusion Criteria:

1. Persistent back and/or leg pain unresponsive to conservative treatment for at least six (6) months, unless clinically indicated earlier
2. Indicated for interbody fusion of one or two contiguous lumbar segments (L1 to L5)
3. Objective evidence of primary diagnosis must be confirmed by appropriate imaging studies
4. 18-80 years of age at the date of written informed consent
5. Able to undergo surgery based on physical exam, medical history and surgeon judgment
6. Expected to survive at least 2 years beyond surgery
7. Willing and able to return for post-treatment exams according to the follow-up called for in the protocol
8. Signed and dated Informed Consent Form

Exclusion Criteria:

1. Patient has a mental or physical condition that would limit the ability to comply with study requirements
2. Lumbar spine abnormality requiring treatment at more than two levels
3. Systemic or local infection; active or latent
4. Previous failed fusion at the operative level
5. Diseases that significantly inhibit bone healing (osteoporosis, metabolic bone disease, uncontrolled diabetes, dialysis dependent renal failure, symptomatic liver disease)
6. Undergoing chemotherapy or radiation treatment, or chronic use of steroids (defined as more than 6 weeks of steroid use within 12 months of surgery, other than episodic use or inhaled corticosteroids)
7. Pregnant, or plans to become pregnant during the study
8. Subject is a prisoner
9. Involvement in active litigation relating to the spine (worker's compensation claim is allowed if it is not contended)
10. A significant general illness (e.g., HIV, active metastatic cancer of any type) is present; subject is immunocompromised or is being treated with immunosuppressive agents
11. Participating in another clinical study that would confound study data

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The proportion of subjects with radiographically apparent fusion.	6-months, 12-months and 24-months

Secondary Outcome Measures

Outcome Measure	Time Frame
The evaluation of angular displacement on flexion/extension films.	Post-op, 6-week, 3-month, 6-month, 12-month, 24-month
The evaluation of bridging bone on CT.	6-month, 12-month
Preservation of interbody height over time.	All post-operative follow-up visits: Post-op, 6-week, 3-month, 6-month, 12-month, 24-month
The rate of complications attributable to the use of Osteocel Plus requiring intervention.	All study follow-up visits: Post-op, 6-week, 3-month, 6-month, 12-month, 24-month
The change in subject self-reported pain ratings (VAS scores).	from baseline through post-operation follow-up (visits at post-op, 6-week, 3-month, 6-month, 12-month and 24-months)
The change in Oswestry Disability Index scores.	from baseline through post-operation follow-up (visits at post-op, 6-week, 3-month, 6-month, 12-month and 24-months)

Collaborators and Investigators

• Sponsor: NuVasive
• Investigators: Study Director: Kelli Howell, MS, NuVasive

Publications and helpful links

Helpful Links

• NuVasive, Inc.

Study record dates

Study Major Dates

• Study Start: March 1, 2009
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: July 16, 2009
• First Submitted That Met QC Criteria: July 27, 2009
• First Posted (Estimate): July 29, 2009

Study Record Updates

• Last Update Posted (Estimate): April 21, 2015
• Last Update Submitted That Met QC Criteria: April 17, 2015
• Last Verified: April 1, 2015

More Information

Terms related to this study

• Keywords: lumbar spine; degenerative disc disease; XLIF; Degenerative conditions
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Spinal Diseases; Bone Diseases; Intervertebral Disc Degeneration
• Other Study ID Numbers: NUVA.OC.0801