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Research ArticleLumbar Spine

Two-Year Outcomes From a Prospective Multicenter Investigation Device Trial of a Novel Conformal Mesh Interbody Fusion Device

John H. Chi, Pierce D. Nunley, Kevin T. Huang, Martin H. Krag, Mohamad Bydon, Stephane Lavoie, Yi Lu, Joseph Driver and Marcus B. Stone
International Journal of Spine Surgery December 2021, 15 (6) 1103-1114; DOI: https://doi.org/10.14444/8169
John H. Chi
1 Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
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Pierce D. Nunley
2 Spine Institute of Louisiana
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Kevin T. Huang
1 Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
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Martin H. Krag
3 Department of Orthopedic Surgery, University of Vermont Medical Center
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Mohamad Bydon
4 Department of Neurosurgery, Mayo Clinic Hospital
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Stephane Lavoie
5 Florida Orthopedic Associates
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Yi Lu
2 Spine Institute of Louisiana
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Joseph Driver
1 Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School
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Marcus B. Stone
2 Spine Institute of Louisiana
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  • Article
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Figures

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  • Figure 1
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    Figure 1

    OptiMesh device filled and unfilled.

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    Figure 2

    Mean Oswestry Disability Index (ODI) scores through 24 months.

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    Figure 3

    Representative computed tomographic images demonstrating fusion in a scoliotic 73-year-old man 12 months after surgery.

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    Figure 4

    Representative computed tomographic images demonstrating fusion in a scoliotic 74-year-old man 24 months after surgery.

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    Figure 5

    Mean low back and leg pain visual analog scale (VAS) scores over time through 24 months.

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    Figure 6

    SF-36 physical and mental component scores over time.

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    Table 1

    Study entrance eligibility criteria.

    Criteria
    Inclusion Criteria
    1. Minimum age of 21 y but not greater than 80 y

    1. Skeletally mature

    1. Have a confirmed diagnosis of lumbar DDD requiring single-level fusion between L2 and S1. Lumbar DDD diagnosis confirmation shall be determined by subject history, physical examination, and radiographic studies with one or more of the following factors:

      • ­ Instability as defined by >3 mm translation or ≥5° angulation

      • ­ Osteophyte formation of facet joints or vertebral endplates

      • ­ Decreased disc height, on average by >2 mm, but dependent upon the spinal level

      • ­ Scarring/thickening of the ligamentum flavum, annulus fibrosis, or facet joint capsule

      • ­ Herniated nucleus pulposus

      • ­ Facet joint degeneration/changes

      • ­ Vacuum phenomenon

    1. Report preoperative low back pain score of ≥40 mm on a 100-mm VAS correlating with involved level

    1. Report preoperative ODI score of ≥40

    1. Received at least 6 months of conservative (nonsurgical) treatment without sufficient relief from symptoms

    1. Willing and able to comply with follow-up evaluations per protocol, including completion of self-assessment survey questionnaire(s), and has read, understood and signed the sponsor and Institutional Review Board–approved site-specific informed consent form

    Exclusion Criteria
    1. Previous implant surgery (ie, fusion procedure or total disc replacement) at the index level (Note: Previous less invasive procedures such as laminectomy, discectomy, etc, at the index level are not considered exclusionary)

    1. Greater than grade I spondylolisthesis

    1. Presents with a diagnosis of symptomatic nonindex level lumbar DDD between L2 and S1. Nonindex level lumbar DDD diagnosis confirmation shall be determined by subject history, physical examination, and radiographic studies with one or more of the following factors:

      • ­ Instability as defined by >3 mm translation or ≥5° angulation

      • ­ Osteophyte formation of facet joints or vertebral endplates

      • ­ Decreased disc height, on average by >2 mm, but dependent upon the spinal level

      • ­ Scarring/thickening of the ligamentum flavum, annulus fibrosis, or facet joint capsule

      • ­ Herniated nucleus pulposus

      • ­ Facet joint degeneration/changes

      • ­ Vacuum phenomenon

    1. Active systemic infection or infection local to the surgical site

    1. Active or suspected malignancy

    1. BMI of ≥40

    1. Significant metabolic bone disease (eg, osteoporosis or osteomalacia) to a degree that would contraindicate spinal instrumentation. Osteoporosis is defined as a T-score of < -2.5 on a DEXA scan A screening questionnaire for osteoporosis, SCORE, will be administered to identify those patients that require a DEXA scan (SCORE ≥6 requires DEXA scan)

    1. Taking medications that are known to potentially interfere with bone or soft tissues healing (eg, chronic systemic steroids)

    1. Has a current diagnosis of substance-related disorder, as defined per DSM-V, May 2013

    1. Has a diagnosis of somatoform, dissociative, eating, or psychotic disorder per DSM–V

    1. Waddell signs of inorganic behavior (3 or more signs)

    1. Is a current tobacco user (current use defined as tobacco use ≤30 d prior to surgery

    1. Is a prisoner at the time of enrollment

    1. If female: pregnant/contemplating pregnancy during the follow-up period

    1. Enrolled in a concurrent clinical investigation that may confound the findings of the present investigation

    • BMI, body mass index; DDD, degenerative disc disease; DEXA, dual-energy x-ray absorptiometry; DSM-V, Diagnostic and Statistical Manual of Mental Disorders 5th Edition; ODI, Oswestry Disability Index; SCORE, simple calculated osteoporosis risk estimate; VAS, visual analog scale.

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    Table 2

    Comorbidities at baseline (N = 102).

    Parameter n (%)
    Respiratory11 (10.8%)
    Cardiovascular31 (30.4%)
    GI/hepatic10 (9.8%)
    General neurologicala 10 (9.8%)
    Spine-related neurologicalb 14 (13.7%)
    Urinary tract/renal5 (4.9%)
    Endocrinec 20 (19.6%)
    General musculoskeletald 18 (17.6%)
    Spine-related musculoskeletale 102 (100.0%)
    Recent surgery8 (7.8%)
    Otherf 12 (11.8%)
    • Thirty-seven percent (37%) presented with a single comorbidity while 26% had two, 21% had three, 9% had four, 6% had five, and 2% had six or more.

    • aGeneral neurological comorbidities include restless leg syndrome, loss of sensation, Parkinson disease, and diabetic neuropathy.

    • bSpinal neurological comorbidities include foot drop, severe stenosis, lower extremity radiculopathy, and pseudoclaudication.

    • cEndocrine comorbidities include diabetes mellitus (10 of 102, 10%).

    • dGeneral musculoskeletal comorbidities include fibromyalgia, osteoarthritis, psoriatic arthritis, and rheumatoid arthritis.

    • eSpine-related musculoskeletal comorbidities include, but are not limited to, sacroiliac disorders and muscle spasming in addition to all patients having symptomatic single-level degenerative disc disease per study entrance criteria.

    • fOther comorbidities include, but are not limited to, 1 patient with Sjorgen syndrome and 1 patient with osteopenia.

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    Table 3

    Study-related serious adverse events.

    Study-Related Serious Adverse Event n
    Required secondary surgical intervention at index level6
    Required surgical intervention at an adjacent level3
    Hematoma requiring evacuation2
    Required intraoperative repair1
    Required hospitalization without surgical intervention3
    Device-related serious adverse events0
    • Includes two device explants

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International Journal of Spine Surgery
Vol. 15, Issue 6
1 Dec 2021
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Two-Year Outcomes From a Prospective Multicenter Investigation Device Trial of a Novel Conformal Mesh Interbody Fusion Device
John H. Chi, Pierce D. Nunley, Kevin T. Huang, Martin H. Krag, Mohamad Bydon, Stephane Lavoie, Yi Lu, Joseph Driver, Marcus B. Stone
International Journal of Spine Surgery Dec 2021, 15 (6) 1103-1114; DOI: 10.14444/8169

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Two-Year Outcomes From a Prospective Multicenter Investigation Device Trial of a Novel Conformal Mesh Interbody Fusion Device
John H. Chi, Pierce D. Nunley, Kevin T. Huang, Martin H. Krag, Mohamad Bydon, Stephane Lavoie, Yi Lu, Joseph Driver, Marcus B. Stone
International Journal of Spine Surgery Dec 2021, 15 (6) 1103-1114; DOI: 10.14444/8169
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Keywords

  • minimally invasive spine surgery
  • degenerative spondylolisthesis
  • lumbar interbody fusion
  • transforaminal lumbar interbody fusion
  • FDA study
  • investigational device exemption

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