- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04166981
Instr. vs. Non-instr. Posterolateral Spinal Fusion in Patients With Spinal Stenosis and Degenerative Listhesis
Instrumented vs. Non-instrumented Posterolateral Spinal Fusion in Patients With Spinal Stenosis and Degenerative Listhesis
Study Overview
Status
Detailed Description
Lumbar spinal stenosis (LSS) is a common disease with a large impact on the quality of life of the patient. LSS is defined as narrowing of the spinal canal, nerve root canal or intervertebral foramina. Spinal stenosis is caused by degenerative changes in the lumbar spine, including thickening of the ligamentum flavum, osteophyte formation and disc protrusion. Pain is worse with standing upright and with exercise, and relieved with spine flexion or sitting down.
In the Wakayama Spine Study, investigators found radiographic severe spinal stenosis, defined as narrowing of more than two-thirds of the spinal canal area, in 30,4% of all patients, but only 17,5% were symptomatic.
Many of the patients suffering from LSS are pensioners, with an average age of 65 years. With current changes in demographics and the aging global population it is estimated that prevalence of LSS will increase to nearly 60% by 2025.
In a Danish epidemiological study, degenerative spondylolisthesis was found in 2,7% of men and 8,4% of women above 50 years. Every year, more than 3500 patients aged 60 and above are referred to Center of Spine Surgery Middelfart for LSS. According to the national Danish surgical spine database, DaneSpine, 7936 patients with LSS had surgery during a period from 2009-2013.
Patients suffering from LSS and instability are treated with decompression and posterolateral spinal fusion with or without instrumentation. According to DaneSpine, this group of patients showed improvements on both physical and psychological parameters. In countries outside of Scandinavia, these patients are usually treated with decompression and posterolateral spinal fusion with supplementary pedicle screw fixation. Instrumentation with pedicle screws and rods provides an internal splint, preventing motion during fusion healing. The fusion rate in non-instrumented arthrodesis is reported to be as low as 30-45% In contrast the fusion rate with instrumented arthrodesis have been reported to be above 80%. Although some studies have shown similar outcomes after decompression with or without instrumentation, long-term follow up has shown that a solid fusion improves clinical outcome.
In recent retrospective studies, the spinal sagittal balance, specifically the sagittal vertical axis (SVA) has been shown to affect the outcome of patients undergoing laminectomy. Decompression surgery has been shown to improve sagittal balance in patients with a preoperative imbalance, compared to patients treated with rehabilitation. The preoperative sagittal imbalance has not been shown to significantly affect health-related quality of life(HRQoL)outcomes although a residual imbalance after decompression is related to a poorer outcome. No prospective studies to our knowledge have compared the sagittal balance and outcomes in patients with spinal stenosis and spondylolisthesis, treated with decompression and spinal fusion with or without supplemental pedicle screw fixation.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Middelfart, Denmark, 5500
- Spine Center of Southern Denmark
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients diagnosed with Lumbar Spinal stenosis, with neurogenic claudication, radicular pain and,
- Confirmatory MRI scan showing lumbar spinal stenosis on 1-2 levels from L1-S1
- Standing X-ray showing grade 1 spondylolisthesis on one level
- Age 60 and above
- Symptom duration of 3+ months
Exclusion Criteria:
- Stenosis caused by herniated disc
- Prior vertebral compression fracture in the affected segments
- Active malignancy
- Current fracture, infection og deformity of the spine
- Stenosis on 3 or more levels
- MMSE test score below 24
- Neuromuscular disease
- Obligatory peroral steroid treatment
- ASA grade 3 or more.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Non-instrumented arm
Decompression with concomitant non-instrumented posterolateral fusion with autologous(obtained from the decompression) and allogenic bone graft.
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Posterolateral fusion with autologous and allogenic bone graft.
Other Names:
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Experimental: Instrumented arm
Decompression with concomitant instrumented posterolateral fusion with autologous(obtained from the decompression) and allogenic bone graft and supplementary pedicle screw fixation.
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Posterolateral fusion with autologous and allogenic bone graft with supplementary pedicle screw fixation.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oswestry Disability Index(ODI)
Time Frame: 2 years after surgery
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A disease specific measure of physical disability in an index score ranging from 0-100, 0 being the best possible outcome and 100 being the worst.
Comparing the effectiveness of the two arms.
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2 years after surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Achieved solid posterolateral fusion
Time Frame: CT-scans 1 year after surgery
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Fine cut CT-scans, evaluated by 3 observers to determine if solid posterolateral fusion is achieved.
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CT-scans 1 year after surgery
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Change in sagittal balance, effect on outcome.
Time Frame: Pre operative, 1 and 2 years after surgery
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Lateral scoliosis X-rays obtained pre operatively and after 1 and 2 years.
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Pre operative, 1 and 2 years after surgery
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European Quality of life - 5 Dimensions (EQ-5D)
Time Frame: preoperative, 3, 12 and 24 months after surgery
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Changes in quality of life in the study groups, Obtained preoperatively, after 3 months, 1 year and 2 years.
Scores range between -0.6 to 1.0 where 1 is perfect health.
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preoperative, 3, 12 and 24 months after surgery
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Difference in cost-effectiveness between instrumented versus non-instrumented fusion.
Time Frame: 2 years after surgery.
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Additional cost of instrumentation, incidence of revision surgery and treatment effectiveness, measured by health state utilities.
Measured in Quality adjusted Life years(QaLY) and cost of surgery measured in American dollars.
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2 years after surgery.
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Zurich Claudication Questionnaire
Time Frame: Preoperative, 1 and 2 years after surgery.
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Disease specific patient reported outcome, to measure changes in function.
The result is expressed as a percentage of the maximum possible score.
The score increases with worsening disability.
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Preoperative, 1 and 2 years after surgery.
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NRS score for leg- and back pain.
Time Frame: Properative, 1 and 2 years after surgery.
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Patient reported leg and back pain.
Obtained preoperatively, after 3 months, 1 year and 2 years.
Score is 0-100, the score increases with worsening pain.
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Properative, 1 and 2 years after surgery.
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Andreas K Andresen, MD, University of Southern Denmark
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- S-20160107
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
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