Spinal Cord Stimulation With Precision® System Versus Reoperation for Failed Back Surgery Syndrome

NCT ID: NCT01036529

Last Updated: 2020-11-16

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2013-05-31

Brief Summary

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The EVIDENCE trial is a randomized controlled trial comparing the therapeutic effectiveness and cost-effectiveness of the Precision® Spinal Cord Stimulation with that of reoperation as a treatment of pain in patients with Failed Back Surgery Syndrome (FBSS). FBSS is defined as persistent or recurrent pain following one or more lumbosacral spine surgical procedures. Surgical procedures that can result in FBSS can be categorized as either decompression or decompression followed by fusion with or without instrumentation. The pain of FBSS is categorized as neuropathic, which involves pathological nerve activity and is commonly characterized by patients as shooting or burning and/or nociceptive, which signals actual or impending tissue damage or inflammation.

Detailed Description

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The co-primary study endpoints are proportion of subjects with ≥50% leg pain relief without crossover at 6 and at 24 months.

Conditions

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Failed Back Surgery Syndrome Pain Back Pain

Keywords

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Spinal Cord Stimulation Decompression Fusion with or without instrumentation Discectomy Laminectomy Laminotomy Foraminotomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Precision Spinal Cord Stimulator

Spinal Cord Stimulation

Group Type EXPERIMENTAL

Precision Spinal Cord Stimulator

Intervention Type DEVICE

Programming settings will be specific to the individual needs in accordance with the labeling

Back Surgery

Discectomy, laminotomy, laminectomy, foraminotomy, fusion with or without instrumentation

Group Type ACTIVE_COMPARATOR

Back Surgery

Intervention Type PROCEDURE

Different types of back surgery may be performed

Interventions

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Precision Spinal Cord Stimulator

Programming settings will be specific to the individual needs in accordance with the labeling

Intervention Type DEVICE

Back Surgery

Different types of back surgery may be performed

Intervention Type PROCEDURE

Other Intervention Names

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Discectomy Laminotomy Laminectomy Foraminotomy Foraminectomy Fusion with or without instrumentation

Eligibility Criteria

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Inclusion Criteria

* Primary pain type - neuropathic with concordant radicular or neurological findings
* Significant complaint of persistent or recurrent radicular leg pain, with or without low back pain
* One or more prior lumbosacral surgical procedures (no upper limit)
* At least 6 months duration of persistent or recurrent radicular leg pain, with or without low back pain
* Study candidates meet the criteria for a specific surgical intervention as recorded by a surgeon: pain refractory to conservative care, with concordant neurologic, tension, and/or mechanical signs and imaging findings of surgically remediable neural compression
* MRI or CT myelogram of the lumbar and thoracic spine (within 12 months prior to screening) that rules out pathology that might compromise SCS electrode placement or pathology, in addition to neural compression, that might contribute to the subject's pain
* All study candidates must pass study site's routine psychological/psychiatric evaluation for SCS before randomization to SCS or reoperation
* At least 18 years of age
* Subject signs informed consent

Exclusion Criteria

* Chief complaint of mechanical low back pain (e.g. pain that a recumbent position relieves completely)
* Pain intensity of always 10 on a 0-10 Numerical Rating Scale over the past 6 months based on subject recall
* Radiographic evidence of frank instability (grossly mobile spondylolisthesis or abnormal subluxation) requiring fusion, calcific arachnoiditis, or severe thoracic stenosis
* Radiographically demonstrated (by myelographic block or its MRI equivalent) critical cauda equinal compression
* A disabling or potentially disabling neurologic deficit (e.g., foot drop, neurogenic bladder) in the distribution of a nerve root or roots caused by surgically remediable compression
* A predominance of non-organic signs on physical exam
* A concurrent clinically significant or disabling chronic pain problem or condition that is likely to confound evaluation of study endpoints (e.g., chronic migraine, significant arthrosis of the hip associated with groin pain as primary complaint)
* Significant substance abuse issues
* Major untreated psychiatric comorbidity
* Unresolved issues of secondary gain (e.g., litigation)
* Expected inability to report treatment outcome adequately
* Expected inability to operate SCS system
* Pregnancy (actual or planned)
* Life expectancy less than 3 years due to other serious medical condition(s)
* Active local or systemic infection
* Prior SCS procedure
* Presence of intrathecal drug pump
* Participation in another clinical study that would confound data of this study
* Occupational risk that would rule out SCS
* Medical or cardiac condition(s) or therapies, or foreseeable need for therapies or diagnostic tests (e.g., MRI), that preclude SCS and/or reoperation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Boston Scientific Corporation

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard North, M.D.

Role: PRINCIPAL_INVESTIGATOR

The Sandra and Malcolm Berman Brain & Spine Institute

Locations

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Scripps Clinic

La Jolla, California, United States

Site Status

University of California San Diego

La Jolla, California, United States

Site Status

Orthopedic Research Foundation

Savannah, Georgia, United States

Site Status

Millenium Pain Center

Bloomington, Illinois, United States

Site Status

Northwestern Memorial Hospital

Chicago, Illinois, United States

Site Status

The University of Illinois Medical Center

Chicago, Illinois, United States

Site Status

Sinai Hospital of Baltimore

Baltimore, Maryland, United States

Site Status

St. Patrick Hospital

Missoula, Montana, United States

Site Status

The Center for Clinical Research, LLC

Winston-Salem, North Carolina, United States

Site Status

Geisinger Medical Center

Danville, Pennsylvania, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Swedish Neuroscience Institute

Seattle, Washington, United States

Site Status

Pacific Medical Center

Seattle, Washington, United States

Site Status

Hopital de Enfant-Jesus

Québec, Quebec, Canada

Site Status

Regina General Hospital

Regina, Saskatchewan, Canada

Site Status

CHU de Nantes-Hopital Laennec

Nantes, , France

Site Status

Frenchay Hospital

Bristol, , United Kingdom

Site Status

James Cook University Hospital

Middlesbrough, , United Kingdom

Site Status

Countries

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United States Canada France United Kingdom

Other Identifiers

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A2005

Identifier Type: -

Identifier Source: org_study_id