- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02291978
MR Guided High Intensity Focused Ultrasound for Lumbar Back Pain
February 20, 2020 updated by: Pejman Ghanouni, Stanford University
A Feasibility Study to Evaluate the Safety and Initial Effectiveness of MR Guided High Intensity Focused Ultrasound (MRgHIFU) in the Treatment of Facetogenic Lumbar Back Pain
The primary purpose of this protocol is to assess the ExAblate 2100 MR guided high intensity focused ultrasound device as an intervention for treatment of facetogenic lower back pain.
Study Overview
Detailed Description
This is a single group, single arm, open/nonblinded, non-randomized study.
The primary outcomes are safety and preliminary efficacy.
The InSightec ExAblate 2100 MRgHIFU system is a non-invasive thermal ablation device fully integrated with an MR imaging system and used for the ablation of soft tissue and bone.The study will reach primary completion 12 months from the time the study opens to accrual.
Study Type
Interventional
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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California
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Stanford, California, United States, 94305
- Stanford University
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
21 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Men and women > 21 years of age and who are skeletally mature
- Body mass index ≤ 30 kg/m2
- Patients who are able to understand and willing to sign a written informed consent document and able to attend all study visits
- Patients with at least 6 months of chronic lower back pain (LBP) localized to the midline or axial low back, with symptoms attributed to the facet joints on physical examination that have persisted despite conservative therapy. Conservative therapy is defined as systemic pain medications and anti-inflammatory medications, as well as physical therapy, such as massage, heating, hydrotherapy, and strengthening exercises.
- Patients with Numerical Rating Scale worst lumbar back pain score of at least 4 out of 10 over the 24 hours preceding the time of rating.
- Patients must have chronic LBP attributed to facet joints as demonstrated by MRI consistent with at least grade 2 facet joint arthritis, with corresponding abnormal activity at the facet joint on 18F-sodium fluoride PET-CT.
- Patients must have an analgesic response to either prior local anesthetic injection to the facet joint or to radiofrequency ablation of the facet joint, with relapse of pain.
- The targeted facet joint must be deeper than 10 mm from the skin
Exclusion Criteria:
- Patients with severe lumbar lordosis
- Patients with contraindication for MR imaging such as implanted metallic devices that are not MRI-safe, size limitations, claustrophobia. etc
- Patients with known intolerance or allergy to MR contrast agent (gadolinium chelates) including advanced kidney disease (GFR <30 mL/min/1.73 m2) or on dialysis
- Pregnant and nursing patients will be excluded from the study because of a contraindication to administering MRI contrast agents to these patients
- Patients with known intolerance or allergy to medications used for sedation (midazolam), analgesia (fentanyl), and local and regional anesthesia (lidocaine, bupivacaine, and ropivacaine)
- Patients with evidence of lumbosacral radiculopathy on MRI or physical exam findings, including radicular leg pain, or any neurologic deficit at or below the segmental level of the highest facet to be treated, including subjects with impaired sphincter control
Patients with pain at another location that
- cannot be distinguished from lumbar back pain
- does not rate at least 2 points less in worst pain score compared to lumbar back pain
- requires the use of analgesics
- Patients with gross spinal instability on imaging
- Patients who have lumbar spinal stabilization hardware in place
Target is:
- NOT visible by non-contrast MRI, OR
- NOT accessible to ExAblate device
- Individuals who are not able or willing to tolerate the required prolonged stationary position during treatment (can be up to 5 hrs of total table time)
- Patients with acute medical condition (e.g. pneumonia, sepsis) that is expected to hinder them from completing this study
Patients with unstable cardiac status including:
- Unstable angina pectoris on medication
- Patients with documented myocardial infarction within six months of protocol entry
- Congestive heart failure requiring medication (other than diuretic)
- Patients on anti-arrhythmic drugs
- Patients with severe hypertension (diastolic BP > 100 on medication)
- Patients with severe hematologic, neurologic, or other uncontrolled disease (e.g. platelets < 50,000/microL, INR > 1.5)
- Patients who are taking anti-thrombotic medication
- Severe cerebrovascular disease (multiple CVAs or CVA within 6 months)
- Patients with inflammatory arthritides.
- Patients unable to communicate with the investigator and staff
- Patients seeking compensation for disability or work injury.
- Patients who are part of another trial testing other Investigational Agents
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ExAblate 2100 Treatment
The ExAblate 2100 system will be used in the MRgHIFU treatment of lower back pain arising from facet joint arthritis.
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The InSightec ExAblate 2100 MRgHIFU system is a non-invasive thermal ablation device fully integrated with an MR imaging system and used for the ablation of soft tissue and bone.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Device Related Complications as a Measure of Safety
Time Frame: 24 months
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Safety will be determined by evaluating for the incidence and severity of any device related complication from the treatment day visit through 24 months after treatment.
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24 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain Relief on the Visual Analog Scale
Time Frame: 24 months
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Effectiveness will be determined by the level of pain relief, as measured by the NRS, and decrease in analgesic/opiate use.
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24 months
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Quality of Life Improvement
Time Frame: 24 months
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Effectiveness will be determined by improved quality of life, as measured by the Oswestry Disability Index.
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24 months
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Pejman Ghanouni, MD, PhD, Stanford University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
October 1, 2014
Primary Completion (Actual)
February 20, 2020
Study Completion (Actual)
February 20, 2020
Study Registration Dates
First Submitted
November 5, 2014
First Submitted That Met QC Criteria
November 12, 2014
First Posted (Estimate)
November 17, 2014
Study Record Updates
Last Update Posted (Actual)
February 24, 2020
Last Update Submitted That Met QC Criteria
February 20, 2020
Last Verified
February 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 29163
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Lumbar Facet Joint Pain
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Complejo Hospitalario Universitario de GranadaUnknownFacet Joint Pain | Facet Syndrome of Lumbar Spine | Facet Joints; DegenerationSpain
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Instituto de Investigación Hospital Universitario...CompletedLumbar Facet Joint Pain | Lumbar Medial Branch NeurotomySpain
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