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Safety and Efficacy of the TransDiscal System Versus Medical Management in Treating Chronic Discogenic Low Back Pain (COLD)

12 juin 2018 mis à jour par: Halyard Health

A Prospective, Randomized, Multi-Center, Open-Label Clinical Trial Comparing Disc Biacuplasty With Medical Management for Discogenic Lumbar Back Pain

The primary objective of this randomized controlled trial is to evaluate the safety and efficacy of the TransDiscal System (TDS) in treating discogenic pain of the lumbar spine using a modified disc biacuplasty procedure. The primary efficacy measure will be the Visual Analog Scale (VAS) at 6 months post treatment/randomization and the TransDiscal System will be compared against medical management (standard of care).

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Description détaillée

The intervertebral discs serve as joints between the vertebral bodies, providing both structural support and flexibility to the spinal column. Intervertebral discs do not remain structurally intact over a lifetime and degenerate as a natural part of aging. Degenerated discs do not react to stresses and forces the same as healthy discs. When too much stress is applied to a degenerated disc, tears can result. Evidence suggests that when a tear is present, sensory nerve endings can grow into the tear and transmit pain.

The TransDiscal System (TDS) is a medical device that is used in a procedure called Disc Biacuplasty and is currently available in the United States and throughout the world. The TDS enables the back of the disc to be heated to high enough temperatures to ablate the nerves inside that are transmitting pain, while maintaining low enough temperatures to prevent damage to surrounding tissues. The TDS uses two electrodes, located at the ends of two thin probes, which are placed on both sides of the back of the intervertebral disc by inserting them through the skin into the disc using x-ray guidance. Radiofrequency (RF) current flows in the disc between the two electrodes, heating the tissue in the disc to the desired temperature. The study evaluates a modified heating protocol than what is currently in clinical use which should allow for a larger area of the back of the disc to be heated.

Type d'étude

Interventionnel

Inscription (Réel)

67

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • États-Unis
    • District of Columbia
      • Washington, District of Columbia, États-Unis, 20037
        • George Washington University Hospital
    • Florida
      • Orlando, Florida, États-Unis, 32806
        • Compass Research
    • Illinois
      • Bloomington, Illinois, États-Unis, 61701
        • Millennium Pain Center
    • Maryland
      • Silver Spring, Maryland, États-Unis, 20910
        • Metro Orthopedics & Sports Therapy
    • New Jersey
      • Linwood, New Jersey, États-Unis, 08221
        • PainCare
    • North Carolina
      • Winston-Salem, North Carolina, États-Unis, 27103
        • Center for Clinical Research
    • Ohio
      • Cleveland, Ohio, États-Unis, 44195
        • Cleveland Clinic
    • Texas
      • Arlington, Texas, États-Unis, 76018
        • JPS Orthopedic & Sports Medicine
    • Washington
      • Seattle, Washington, États-Unis, 98105
        • Center for Pain Relief, University of Washington

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

21 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Age ≥21 years
  • Able to understand the informed consent and able to complete outcome measures
  • Objective measurements indicating functional impairment related to low back pain
  • Stabilized on pain medication regimen for >2 months as defined by a <10% change in dosage
  • History of chronic low back pain (>6 months) unresponsive to non-operative care (including physical therapy, anti-inflammatory medication, epidurals, diagnostic facet joint/medial branch blocks, and sacroiliac joint interventions as performed or deemed appropriate by the Investigator)
  • Score ≥5 on the Visual Analog Scale (VAS) relating specifically to the average daily low back pain
  • Back pain more prominent than leg pain which is commonly exacerbated by flexion or bending or prolonged sitting.
  • Single level concordant pain reproduction present on lumbar discography in desiccated disc. Magnetic resonance Imaging (MRI) image also supports discography findings. Changes in other disc spaces in the lumbar region do not demonstrate neural compressive lesion.
  • Disc height at least 50% of adjacent control disc

Exclusion Criteria:

  • Evidence of compressive radiculopathy with predominant leg pain
  • Evidence of nucleus pulposus herniation or free disc fragments on MRI
  • Evidence of > 2 discs dessicated based on MRI or symptomatic involvement of more than one lumbar disc levels.
  • Asymptomatic disc bulges > 5 mm at the treatment level.
  • Prior lumbar surgery of any kind at the treatment level (micro-discectomies, and/or minimally invasive procedures at other levels that are not excluded)
  • Prior spinal fusion below the T10 Level
  • Symptoms or signs of lumbar canal stenosis at any level
  • Evidence of structural abnormality at the lumbar level (except non-symptomatic spondylolysis resulting in spondylolithesis no more than Grade 1 upon flexion and extension)
  • Any generalized pain or multifocal pain,conversion or multiple non-anatomical complaints
  • Pending or active compensation claim, litigation or disability income remuneration (secondary gain)
  • Chronic pain associated with significant psychosocial dysfunction
  • Beck's Depression Index (BDI) score >20
  • Current pregnancy, recent delivery (within 3 months of consent) or the intent of becoming pregnant during the study period.
  • Systemic or localized infection at the anticipated needle entry site (subject may be considered for inclusion once infection is resolved)
  • Discitis
  • Allergies to any medication to be used in the procedure
  • Present symptomatic lumbar spinal fracture
  • History of uncontrolled coagulopathy, ongoing coagulation treatment or unexplained or uncontrollable bleeding that is uncorrectable
  • Progressive neurological deficits
  • Within the preceding 2 years, subject has suffered from active narcotic addiction, substance abuse or alcohol abuse
  • Current prescribed opioid medications equivalent to >120 mg of morphine per 24 hours
  • Uncontrolled immunosuppression (e.g. Acquired Immune Deficiency Syndrome [AIDS], cancer, diabetes, etc.)
  • Body Mass Index (BMI) >32.5 kg/m^2
  • Participating in another clinical trial/investigation 30 days prior to signing informed consent
  • Negative or indeterminate lumbar discography results as assessed per International Spine Intervention Society (ISIS) guidelines
  • Subject unwilling or unable to comply with follow up schedule or protocol requirements.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: TransDiscal System
Kimberly-Clark TransDiscal System in addition to standard medical management
Dispositif: TransDiscal System
Surgical Procedure using the TransDiscal System to perform disc biacuplasty.
Autres noms:
  • TransDiscal,disc biacuplasty,disc,ablation,low back pain
Autre: Medical Management
Standard medical management
Autre: Medical Management
Standard medical management, physical therapy, and lifestyle changes.
Autres noms:
  • physical therapy, medications,

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Change in Average Daily Pain Visual Analog Scale (VAS) Score Between Screening and Follow up.
Délai: Baseline and 6 months
Visual Analog Scale (NRS) - score range = 0 - 10. "0" corresponds to "no pain" and "10" indicates "worst pain imaginable". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Percentage of Study Group Subjects With Greater Than 2 Points Decrease or 30% Drop in Average Daily Pain Related Visual Analog Scale (VAS) Score.
Délai: Baseline and 6 months
Visual Analog Scale (NRS) - score range = 0 - 10. "0" corresponds to "no pain" and "10" indicates "worst pain imaginable". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months
Mean Change in Score of Short Form 36-Physical Functioning (SF36-PF) From Screening to 6 Month Follow up Visit
Délai: Baseline and 6 months
Short Form 36-PF - score range = 0 - 100. "0" corresponds to "greatest disability" and "100" indicates "no disability". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months
Mean Change in Score of EuroQuol 5d Visual Analog Scale (EQ-5d VAS) Between Screening and 6 Month Follow up Visit
Délai: Baseline and 6 months
EQ-5d VAS - score range = 0 - 100. "0" corresponds to the "worst imaginable health state" and "100" indicates the "best imaginable health state". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months
Mean Change in Score of Beck's Depression Inventory (BDI) Between Screening and 6 Month Follow up Visit
Délai: Baseline and 6 months
BDI - score range = 0 - 63. "0" corresponds to "minimal depression" and "63" indicates "severe depression". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months
Mean Change in Score of Patient Global Impression of Change (PGIC) Between Screening and 6 Month Follow up Visit
Délai: Baseline and 6 months
PGIC - score range = 1 - 7. "1" corresponds to "very much improved" and "7" indicates "very much worse" pertaining to overall activity, symptoms, emotions, and quality of life. The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 months
Mean Change in Score of Oswestry Disability Index (ODI) Between Screening and 6 Month Follow up Visit
Délai: Baseline and 6 Months
ODI - score range = 0 - 100. "0" corresponds to "no disability" and "100" indicates the "maximum disability possible". The means of these scores and their respective standard deviations are reported for each study group.
Baseline and 6 Months

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Halyard Health

Les enquêteurs

  • Directeur d'études: David Curd, MS, Halyard Health, Inc.

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 décembre 2010

Achèvement primaire (Réel)

1 décembre 2014

Achèvement de l'étude (Réel)

1 avril 2015

Dates d'inscription aux études

Première soumission

29 novembre 2010

Première soumission répondant aux critères de contrôle qualité

16 décembre 2010

Première publication (Estimation)

20 décembre 2010

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

10 juillet 2018

Dernière mise à jour soumise répondant aux critères de contrôle qualité

12 juin 2018

Dernière vérification

1 mars 2015

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • 100-10-0001

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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