Proximal Junctional Kyphosis Following Long Instrumented Spinal Fusion: The Effect of Implant Selection

NCT ID: NCT01441999

Last Updated: 2019-08-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2011-10-31

Study Completion Date

2017-03-31

Brief Summary

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The treatment of adult deformity has improved with the development and use of modern segmental instrumentation, including posterior instrumentation. However, the incidence of proximal junctional kyphosis (PJK) caused by the accelerated degeneration of the joint capsules and smaller articular processes in the proximal junctional region has also been noted.

One potential way of decreasing PJK is to decrease the structural rigidity of the construct at the top thereby providing a transition to the non-instrumented spine and allowing for less facet capsule and muscle disruption.

Detailed Description

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While a possible solution to PJK is to reduce structural rigidity at the top of the construct, there is a need to investigate it. In the proposed study, the investigators will compare the rate of proximal junctional kyphosis in patients treated with a stainless steel rod (REVERE Stabilization System) versus those treated with TRANSITION Stabilization System.

Patient outcome measures (Scoliosis Research Society (SRS-22), SF12 and ODI) and radiographic measurements (including lumbar lordosis (L1-S1), adjacent segment kyphosis, thoracolumbar kyphosis (T10-L2), sagittal balance, sacral slope, and pelvic incidence) will be analyzed.

Conditions

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Kyphosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Less rigid rods

Titanium rods that have a soft, plastic end

Group Type ACTIVE_COMPARATOR

Less rigid rod

Intervention Type DEVICE

Titanium rod with semi rigid end

Rigid Rods

Titanium rods

Group Type ACTIVE_COMPARATOR

Rigid Rod

Intervention Type DEVICE

Rigid Titanium rods

Interventions

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Less rigid rod

Titanium rod with semi rigid end

Intervention Type DEVICE

Rigid Rod

Rigid Titanium rods

Intervention Type DEVICE

Other Intervention Names

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TRANSITION REVERE

Eligibility Criteria

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Inclusion Criteria

* Adult patients with degenerative spondylolisthesis with objective evidence of neurologic impairment, kyphosis, and failed previous fusion (pseudoarthrosis) requiring treatment with an instrumented posterior fusion from the thoracolumbar junction (T10-L1) to the sacrum
* At least 18 years of age and maximum 70 years of age
* Ability to provide Informed Consent for study participation and patients to return for all follow-up visits

Exclusion Criteria

* Presence of systemic or localized infection
* Previous fusion attempt at the involved level(s)
* More than three previous open, posterior, lumbar spinal surgical procedures at the involved level(s)
* Trauma at the levels to be fused
* Previous documentation of osteopenia or osteomalacia
* Diagnosis of a condition or requires postoperative medication(s), which may interfere with bony/soft tissue healing
* Presence of a disease entity or condition which totally precludes possibility of bony fusion (e.g. metastatic cancer, HIV, long term use of steroids, etc.)
* Immunosuppressive disorder
* Pregnancy
* History of alcohol and/or drug abuse
* Any known allergy to a metal alloy
* Mentally incompetent or prisoner
* Currently a participant in another study
* Preoperative structural deformity in the thoracic spine (kyphosis \>60 degrees, Coronal curve \>40 degrees)
* Circumferential fusion above L1
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Michigan

OTHER

Sponsor Role collaborator

Polaris Spine and Neurosurgery Center

OTHER

Sponsor Role collaborator

Globus Medical Inc

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bryan Cunningham, PhD

Role: STUDY_DIRECTOR

Globus Medical Inc

Locations

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Peachtree Neurosurgery

Atlanta, Georgia, United States

Site Status

Department of Neurosurgery, University of Michigan

Ann Arbor, Michigan, United States

Site Status

Department of Orthopedic Surgery, University of Copenhagen, Denmark

Copenhagen, , Denmark

Site Status

Countries

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United States Denmark

References

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Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C 2nd. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005 Jul 15;30(14):1643-9. doi: 10.1097/01.brs.0000169451.76359.49.

Reference Type BACKGROUND
PMID: 16025035 (View on PubMed)

Hee HT, Yu ZR, Wong HK. Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine (Phila Pa 1976). 2007 Jun 15;32(14):1533-42. doi: 10.1097/BRS.0b013e318067dc3d.

Reference Type BACKGROUND
PMID: 17572624 (View on PubMed)

Hollenbeck SM, Glattes RC, Asher MA, Lai SM, Burton DC. The prevalence of increased proximal junctional flexion following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2008 Jul 1;33(15):1675-81. doi: 10.1097/BRS.0b013e31817b5bea.

Reference Type BACKGROUND
PMID: 18580741 (View on PubMed)

Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine (Phila Pa 1976). 2005 Sep 15;30(18):2045-50. doi: 10.1097/01.brs.0000179084.45839.ad.

Reference Type BACKGROUND
PMID: 16166893 (View on PubMed)

Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976). 2007 Nov 15;32(24):2731-8. doi: 10.1097/BRS.0b013e31815a7ead.

Reference Type BACKGROUND
PMID: 18007253 (View on PubMed)

Lee GA, Betz RR, Clements DH 3rd, Huss GK. Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine (Phila Pa 1976). 1999 Apr 15;24(8):795-9. doi: 10.1097/00007632-199904150-00011.

Reference Type BACKGROUND
PMID: 10222531 (View on PubMed)

Yang SH, Chen PQ. Proximal kyphosis after short posterior fusion for thoracolumbar scoliosis. Clin Orthop Relat Res. 2003 Jun;(411):152-8. doi: 10.1097/01.blo.0000069885.72909.bb.

Reference Type BACKGROUND
PMID: 12782870 (View on PubMed)

Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976). 2008 Sep 15;33(20):2179-84. doi: 10.1097/BRS.0b013e31817c0428.

Reference Type BACKGROUND
PMID: 18794759 (View on PubMed)

Helgeson MD, Shah SA, Newton PO, Clements DH 3rd, Betz RR, Marks MC, Bastrom T; Harms Study Group. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976). 2010 Jan 15;35(2):177-81. doi: 10.1097/BRS.0b013e3181c77f8c.

Reference Type BACKGROUND
PMID: 20081513 (View on PubMed)

Wang J, Zhao Y, Shen B, Wang C, Li M. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury. 2010 Apr;41(4):415-20. doi: 10.1016/j.injury.2010.01.001. Epub 2010 Jan 27.

Reference Type BACKGROUND
PMID: 20106476 (View on PubMed)

Bunge EM, Juttmann RE, de Kleuver M, van Biezen FC, de Koning HJ; NESCIO group. Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. Eur Spine J. 2007 Jan;16(1):83-9. doi: 10.1007/s00586-006-0097-9. Epub 2006 Apr 12.

Reference Type BACKGROUND
PMID: 16609857 (View on PubMed)

Taylor TC, Wenger DR, Stephen J, Gillespie R, Bobechko WP. Surgical management of thoracic kyphosis in adolescents. J Bone Joint Surg Am. 1979 Jun;61(4):496-503.

Reference Type BACKGROUND
PMID: 438235 (View on PubMed)

Glassman SD, Schwab F, Bridwell KH, Shaffrey C, Horton W, Hu S. Do 1-year outcomes predict 2-year outcomes for adult deformity surgery? Spine J. 2009 Apr;9(4):317-22. doi: 10.1016/j.spinee.2008.06.450. Epub 2008 Sep 6.

Reference Type BACKGROUND
PMID: 18774752 (View on PubMed)

Other Identifiers

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RGC11-001

Identifier Type: -

Identifier Source: org_study_id

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