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Trinity Evolution in Anterior Cervical Disectomy and Fusion (ACDF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00951938
Recruitment Status : Completed
First Posted : August 4, 2009
Last Update Posted : April 8, 2014
Information provided by (Responsible Party):
Orthofix Inc.

Brief Summary:
The purpose of this study is to utilize Trinity Evolution in conjunction with an interbody spacer and supplemental anterior fixation of the surgeon's choice and to follow the patients to measure the clinical outcomes and rate of fusion. The hypothesis of the study is that Trinity Evolution combined with an interbody spacer and supplemental anterior fixation will result in fusion rates and clinical outcomes similar to those with other routinely used autograft and allograft materials including: fusion, improvement in pain and function, maintenance of upper extremity neurological function, and absence of serious adverse events related to the use of the Trinity Evolution product.

Condition or disease
Degenerative Disc Disease

Detailed Description:

When conservative care fails to alleviate the pain and neurological deficits caused by degenerative disc disease in a cervical spine, the most common recourse is surgical decompression of the affected nerves and/or spinal cord. Decompression is often accomplished via an anterior approach whereby essentially the entire disc as well as any bony osteophytes and ligaments that are compressing the spinal cord and/or nerves are removed. While usually successful at decompressing affected neural structures, the decompression often results in collapse of the disc space, instability and recurrent symptomatology.

Most anterior cervical decompressions therefore are followed by insertion of a structural interbody spacer such as a bone graft from the patient's iliac crest (autograft) or a bone graft from a cadaver (allograft). The "gold standard" for aiding healing in spinal fusion surgeries is the harvesting of autograft from the patient's iliac crest and placing it in and around the segments of the spine that are intended to be fused. Autograft is considered the "gold standard" because it contains the essential elements required for successful bone grafting: osteogenesis, osteoconduction, and osteoinduction.

However, the morbidity of harvesting autograft has been well documented and includes chronic donor-site pain, infection, neurologic injury, blood loss, deformity, bowel injury, hernia, and prolonged surgical and hospitalization time. There are now a number of products on the market to minimize or replace the use of autograft. However, few of these products contain all three essential bone-forming elements (osteogenesis, osteoconduction, and osteoinduction) in a single, stand alone product.

Trinity Evolution is a novel, allogeneic cancellous bone matrix containing viable osteoprogenitor cells, mesenchymal stem cells and demineralized cortical bone (DCB) component to provide the required osteoconduction, osteogenesis, and osteoinduction necessary for successful bone grafting. Preclinical studies with Trinity Evolution have demonstrated in-vitro and in-vivo safety and effectiveness. Trinity Evolution is considered an allograft and as such is a "minimally manipulated" tissue and is labeled for bone repair for spinal, orthopedic and podiatric indications where autograft is used. The dosage will be dependent upon the specific requirements of the case.

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Study Type : Observational
Actual Enrollment : 200 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: A Radiographic and Clinical Study Evaluating a Novel Allogeneic, Cancellous, Bone Matrix Containing Viable Stem Cells (Trinity Evolution™ Viable Cryopreserved Cellular Bone Matrix) in Patients Undergoing Anterior Cervical Discectomy and Fusion
Study Start Date : August 2009
Actual Primary Completion Date : August 2012
Actual Study Completion Date : August 2012

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Fusion Rates for Trinity Evolution [ Time Frame: Operative to 12 months Follow-up ]

Secondary Outcome Measures :
  1. NDI relative improvement, VAS improvement, Maintenance or improvement of neurological function [ Time Frame: Pre-operative to 12 months follow-up ]
  2. Complication Rates for Trinity Evolution [ Time Frame: Operative to 12 months follow-up ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Subject selection will be conducted by patient's neurosurgeon or orthopedic surgeon.

Inclusion Criteria:

  • Symptomatic cervical degenerative disc disease at up to four levels between C3 and T1
  • Neck and/or arm pain and/or a functional neurological deficit, and/or cervical myelopathy with neural compression confirmed by plain x-rays and MRI, Myelogram or CT. Scheduled for an ACDF with a spacer and anterior supplemental fixation of the surgeon's choice.
  • Greater than 18 years of age
  • Unresponsive to conservative care over a period of at least 6 weeks or has progressive neurological signs and/or symptoms of neurological compromise that mandate urgent surgical intervention.
  • Willing and able to comply with the requirements of the protocol including follow-up requirements
  • Willing and able to sign a study specific informed consent.

Exclusion Criteria:

  • More than 4 levels (C3 - T1) requiring surgical treatment
  • Active local or systemic infection
  • Currently pregnant or considering becoming pregnant during the follow-up period
  • Active malignancy or having been on chemotherapy of any kind for a malignancy in the past 1 year.
  • Axial neck pain as the primary diagnosis, without evidence of neural compression
  • Use of any other bone graft or bone graft substitute in addition to or in place of Trinity Evolution in and around the interbody spacer
  • Use of adjunctive post-operative stimulation
  • Prior interbody surgery at the same level
  • Has a known history of hypersensitivity or anaphylactic reaction to dimethyl sulfoxide (DMSO).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00951938

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United States, California
CORE Orthopaedic Medical Center
Encinitas, California, United States, 92024
Shasta Orthopaedics Spine Center
Redding, California, United States, 96001
United States, Colorado
Denver-Vail Orthopedics, P.C.
Parker, Colorado, United States, 80134
United States, Connecticut
Central Connecticut Neurosurgery and Spine
New Britain, Connecticut, United States, 28204
United States, Kansas
Kansas University Medical Center
Kansas City, Kansas, United States, 66160
United States, Michigan
University of Michigan, A. Alfred Taubman Health Care Center
Ann Arbor, Michigan, United States, 48109-5338
United States, Nevada
Western Regional Center for Spine and Brain Surgery
Las Vegas, Nevada, United States, 89109
United States, North Carolina
Carolina NeuroSurgery & Spine
Charlotte, North Carolina, United States, 28204
Triangle Neurosurgery
Raleigh, North Carolina, United States, 27607
United States, Pennsylvania
Jefferson Medical College
Philadelphia, Pennsylvania, United States, 19107
United States, Texas
Greater Houston Neurosurgery Center
The Woodlands, Texas, United States, 77381
United States, Virginia
The Virginia Spine Institute
Reston, Virginia, United States, 20190
Tuckahoe Orthopaedic Associates
Richmond, Virginia, United States, 23226
Sponsors and Collaborators
Orthofix Inc.
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Study Director: Raymond J Linovitz, MD Orthofix Spinal Implants
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Orthofix Inc. Identifier: NCT00951938    
Other Study ID Numbers: CP-01005A
First Posted: August 4, 2009    Key Record Dates
Last Update Posted: April 8, 2014
Last Verified: April 2014
Keywords provided by Orthofix Inc.:
Trinity Evolution
Anterior Cervical Discectomy and Fusion
Additional relevant MeSH terms:
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Intervertebral Disc Degeneration
Spinal Diseases
Bone Diseases
Musculoskeletal Diseases