Pivotal Study of rhBMP-2/ACS/Allograft Bone Dowel for Anterior Lumbar Interbody Fusion in Patients With Symptomatic Degenerative Disc Disease

• Disc Height Measurement [ Time Frame: 24 month ] [ Designated as safety issue: No ]
• General Health Status (SF-36) [ Time Frame: 24 month ] [ Designated as safety issue: No ]
• Back and Leg Pain Status (Numerical Rating Scale) [ Time Frame: 24 month ] [ Designated as safety issue: No ]
• Patient Satisfaction [ Time Frame: 24 month ] [ Designated as safety issue: No ]
• Patient Global Perceived Effect [ Time Frame: 24 month ] [ Designated as safety issue: No ]

The purpose of this clinical trial is to evaluate the implant (rhBMP-2/ACS/allograft bone dowel) as a method of facilitating spinal fusion in patients with degenerative disc disease.

• Procedure: rhBMP-2/ACS/allograft bone dowel
  The rhBMP-2/ACS used in conjunction with an allograft bone dowel.
  Other Name: Recombinant human bone morphogenetic protein-2
• Procedure: Autogenous bone/allograft bone dowel
  An allograft bone dowel containing autogenous bone taken from the patient's iliac crest.
  Other Name: Autograft

• Experimental: rhBMP-2/ACS
  Intervention: Procedure: rhBMP-2/ACS/allograft bone dowel
• Active Comparator: Autogenous Bone
  Intervention: Procedure: Autogenous bone/allograft bone dowel

Inclusion Criteria:

1. Has degenerative disc disease as noted by back pain of discogenic origin, with or without leg pain, with degeneration of the disc confirmed by patient history ( e.g.,pain [leg, back, or symptoms in the sciatic nerve distribution], function deficit and/or neurological deficit)and radiographic studies ( e.g., CT, MRl, X-Ray, etc.) to include one or more of the following:

   • instability( defined as angular motion > 5° and/or translation >= 2-4mm, based on Flex/Ext radiographs);
   • osteophyte formation;
   • decreased disc height;
   • thickening of ligamentous tissue;
   • disc degeneration or herniation; and/or
   • facet joint degeneration.
2. Has preoperative Oswestry score > 35.
3. Has no greater than Grade 1 spondylolisthesis utilizing Meyerding's Classification (Meyerding HW, 1932.).
4. Has single-level symptomatic degenerative involvement from L4 to S1.
5. Is at least 18 years of age, inclusive, at the time of surgery.
6. Has not responded to non-operative treatment (e.g., bed rest, physical therapy, medications, spinal injections, manipulation, and/or TENS) for a period of at least 6 months.
7. If female of child-bearing potential, who is not pregnant or nursing, and who agrees to use adequate contraception for 16 weeks following surgery.
8. Is willing and able to comply with the study plan and sign the Patient Informed Consent Form.

Exclusion Criteria:

1. Had previous anterior spinal fusion surgical procedure at the involved level.
2. Has posterior spinal instrumentation (which will not be removed) stabilizing the involved level or has had a previous posterior lumbar interbody fusion procedure at the involved level.
3. Has a condition which requires postoperative medications that interfere with fusion, such as steroids or nonsteroidal antiinflammatory drugs (this does not include low dose aspirin for prophylactic anticoagulation or perioperative steroids).
4. Has osteopenia, osteoporosis, or osteomalacia to a degree that spinal instrumentation would be contraindicated.
5. Has presence of active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin).
6. Has overt or active bacterial infection, either local or systemic.
7. Is obese, i.e., weight greater than 40% over ideal for their age and height.
8. Has fever (temperature> 101°F oral) at the time of surgery.
9. Is mentally incompetent. If questionable, obtain psychiatric consult.
10. Has a Waddell Signs of Inorganic Behavior score of 3 or greater.
11. Is a prisoner.
12. Is an alcohol and/or drug abuser as defined by currently undergoing treatment for alcohol and/or drug abuse.
13. Is a tobacco user at the time of surgery.
14. Has received drugs which may interfere with bone metabolism within two weeks prior to the planned date of spinal fusion surgery (e.g., steroids or methotrexate).
15. Has a history of autoimmune disease (Systemic Lupus Erythematosus or Dermatomyositis).
16. Has a history of exposure to injectable collagen implants.
17. Has a history of hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins) or collagen.
18. Has received treatment with an investigational therapy within 28 days prior to implantation surgery or such treatment is planned during the 16 weeks following rhBMP-2/ACS implantation.
19. Has received any previous exposure to any/all BMP's of either human or animal extraction.
20. Has a history of allergy to bovine products or a history of anaphylaxis.
21. Has history of endocrine or metabolic disorder known to affect osteogenesis (e.g., Paget's disease, renal osteodystrophy, Ehlers-Danlos syndrome, or osteogenesis imperfecta).