An Assessment of P-15 Bone Putty in Anterior Cervical Fusion With Instrumentation

• Radiologic fusion [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Neck Disability Index (NDI) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Neurologic Success [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Safety Outcomes [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

• The difference in the fusion rates at twelve months between the investigational device and the control group will be greater than -ten
• The difference in average neck disability index values at twelve months between the investigational device and the control group will be greater than eleven points.
• Difference in pain (arm) measured by VAS at twelve months between the investigational and the control group will be greater than 1,8 points
• Difference in pain (neck) measured by VAS at twelve months between the investigational and the control group will be greater than 1.8 points

• Pain Neck Visual Analog Scale (VAS) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Pain shoulder and arm Visual Analog Scale (VAS) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Success rates measured by aggregated modified Odom's criteria [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Short Form 36 v2 Physical Health Composite Score (PCS) and Mental Health Composite Score (MCS) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Kyphosis [ Time Frame: 12 ] [ Designated as safety issue: No ]

• Kyphosis rates at twelve months will not differ between the experimental and the control group
• Standardized SF-36 and composite scores (PCS and MCS) values at twelve months will not differ between the experimental and the control group
• Success rates measured by aggregated modified Odom's criteria at twelve months will differ between the experimental and the control group
• Complication rates at twelve months will differ between the experimental and the control group

The aim of this trial is to evaluate if P-15 bone putty (investigational device) is not inferior in effectiveness and safety to local autologous bone (control device) when applied in instrumented anterior cervical discectomy and fusion (ACDF) with use of a structural allograft ring in patients with degenerative cervical disc disease..

Anterior Cervical Discectomy and Fusion (ACDF) is a common surgical treatment option for symptomatic degenerative cervical disk disease in patients who fail conservative treatment. i-FACTOR bone graft is a unique anorganic bone mineral (ABM) and small peptide, P-15™. P-15 is a synthetic fifteen amino acid polypeptide that mimics the cell-binding domain of Type I human collagen and is responsible for osteogenic cell attachment via alpha2-beta1 integrins.

This is randomized, controlled, multi-center, prospective FDA IDE study conducted to assess the safety and effectiveness of i-FACTOR bone graft (Cerapedics, Inc. Westminster, CO) in patients treated with single level ACDF. Patients received i-FACTOR bone graft or local autologous bone inside a structural allograft.

• Device: P-15 Synthetic osteoconductive bone substitute
  Safety and efficacy of synthetic bone substitute used for fusion in spinal surgery
  Other Name: i-Factor
• Other: Autologous bone
  Local autologous bone will be harvested, milled and placed into teh cavity o fthe structural allograft ring

• Experimental: Bone graft substitute
  Subjects will receive anterior cervical discectomy with fusion and instrumentation (anterior plate). Structural allograft ring will be used. The cavity of the ring will be filled with investigational device (P15).
  Intervention: Device: P-15 Synthetic osteoconductive bone substitute
• Active Comparator: Autologous Bone
  Subjects will receive anterior cervical discectomy with fusion and instrumentation (anterior plate). Structural allograft ring will be used. The cavity of the ring will be filled with local autologous bone.
  Intervention: Other: Autologous bone

Inclusion Criteria:

• Age between 18 and 65
• Radiographically determined discogenic origin to include at least one of the following characteristics: Degenerated/dark disc on MRI, decreased disc height compared to adjacent levels on radiographic film, CT, or MRI and disc herniation on CT or MRI
• Radicular symptoms by history and physical exam to include at least the following characteristics: Arm/shoulder pain, decreased flexes, decreased strenght and abnormal sensation
• pain level arm/shoulder >4 on 0-10 VAS
• pain level neck >4 on 0-10 VAS
• Neck disability Index >30
• Involved discs between C3 and C7
• Undergoing anterior cervical fusion at a single level
• Failed to gain adequate relief from non-operative treatment
• Able and willing to give consent to participate in study
• Understand and read english at elementary level

Exclusion Criteria:

Systemic infection such as AIDS, HIV, and active hepatitis; Significant metabolic disease that in the surgeon's opinion might compromise bone growth such as osteoporosis or osteomalacia; Taking medication for the prevention of osteoporosis; Circulatory, cardiac, or pulmonary problems that could cause excessive surgical risk; Active malignancy; Nondiscogenic source of symptoms (e.g., tumor, etc.); Multiple level symptomatic degenerative disc disease; Previous cervical fusion; Previous cervical decompression at the same level; Acute cervical trauma or instability (i.e., subluxation > 3 mm on flexion/extension radiographic film); Undergoing treatment for tumor or boney traumatic injury to the cervical spine; Rheumatoid disease of the cervical spine; Myelopathy; Pregnant or planning to become pregnant in the next 2 years; Posterior cervical spine procedure scheduled; More than one level to be operated; Has a history of substance abuse (recreational drugs, alcohol); Is a prisoner; Is currently involved in a study of another investigational product for similar purpose; Has a disease process that would preclude accurate evaluation (e.g., neuromuscular disease, significant psychiatric disease).