Circumferential Vertebral Reconstruction of Osteoporotic Compression Fractures Using a Novel Bipedicular Peek Implant (RECONSTRUCT)

Mount Sinai Health System

Status

Active, not recruiting

Conditions

Vertebral Compression Fractures

Osteoporotic Vertebral Compression Fractures

Treatments

Procedure: Vertebral Implant PEEK Procedure

Device: Vertebral Implant PEEK (VIP) implant

Study type

Interventional

Funder types

Other

Identifiers

NCT05337696

STUDY-21-01269

Details and patient eligibility

About

The RECONSTRUCT study is a multi-center, prospective, single arm, post-market, pilot study to evaluate clinical and radiologic outcome data regarding the use of the Vertebral Implant PEEK (VIP) implant in the treatment of symptomatic, acute (<8week) vertebral compression fractures who have failed conservative care strategies.

Full description

Vertebral compression fractures affect an estimated 1.4 million patients in the world annually and incidence rates rise exponentially with age, especially in women. Outcomes following non-interventional management of these injuries are generally poor, largely as a consequence of opioid requirements, prolonged immobilization, and bedrest. As a result, interventional techniques such as balloon kyphoplasty and vertebroplasty with or without implantable devices are currently regarded as the standard of care for select patients with acute painful osteoporotic compression fractures. These procedures relieve fracture pain by stabilizing the fracture site using cement.

Alternative interventional techniques include percutaneous vertebral augmentation, which combine cement injection with implantable devices, such as the SpineJack® and KIVA® devices. The RECONSTRUCT study will build on the outcomes of the SAKOS and KAST clinical trails that evaluated the SpineJack® and KIVA® devices, respectively.

The Vertebral Implant PEEK (VIP) implant (V-STRUT© manufactured by Hyprevention) has undergone both clinical and pre-clinical testing. Static and dynamic bending of the implant has been evaluated to demonstrate that the product is capable of supporting in-situ loading, and increase fracture load and energy to fracture.

A total of 30 eligible subjects with a diagnosis of osteoporotic fractures of the thoracolumbar spine, as confirmed by MRI scan, and who are treated with the Vertebral Implant PEEK (VIP) device will be asked to join the study. No placebo or control will be utilized during this study.

RECONSTRUCT has been designed with the intention of achieving two goals: 1) to inform the design of larger controlled clinical trials in the future and 2) to assess the safety of the study device within the patient sample.

Enrollment

30 estimated patients

Sex

All

Ages

50+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age ≥ 50
Osteoporotic compression fractures of the thoracolumbar spine (T9 -L5)
Fracture age of ≤ 8 weeks as indicated by onset of pain or known antecedent traumatic event with corresponding evidence of acuity on MRI (T1 and STIR sequences) or radioisotope bone scan
ODI ≥ 30/100 at screening visit and VAS ≥ 60 at screening visit
Failure of conservative management strategies for compression fractures resulting in inadequately controlled pain and/or patient immobility
Patient has failed non-operative medical therapy as defined by one of the following definitions set forth by the American College of Radiology:
1. For a patient rendered nonambulatory as a result of pain from a VCF, pain persisting at a level that prevents ambulation despite 24 hours of analgesic therapy; or
2. For a patient with sufficient pain from a VCF such that physical therapy is intolerable, pain persisting at that level despite 24 hours of analgesic therapy; or
3. For a patient with pain from a VCF, unacceptable side effects such as excessive sedation, confusion, or constipation as a result of the analgesic therapy necessary to reduce pain to a tolerable level.
Magerl classification A1.1, A1.2, A1.3, A2.1, A2.2 and A3.1 type fractures
Appropriate pedicle diameter to receive 5.5mm diameter or 6.5mm diameter implants
ASA < 4

Exclusion criteria

Patient clearly improving on conservative treatment
Any contra-indication or allergy to implant material or cement
Systemic infection or infection located in the spine
Any medical condition including but not limited to anemia, coagulation disorders, fibromyalgia, algoneurodystrophy, Paget's disease, uncontrolled diabetes that would preclude the patient from having surgery or would impede the benefit of surgery
Neurologic signs or symptoms related to the fracture or the impeding pathological fracture
Any previous surgical treatment (material or cement) in the targeted vertebra
Less than one third of the original vertebral body height remaining
Unstable fractures or neoplasms with posterior involvement
Damages of the pedicles or posterior wall
Sclerotic cancellous bone
Pedicles not large enough to accept V-STRUT© instrumentation and implants
Pregnancy(women of childbearing potential must have a negative pregnancy test to participate)
Pre-existing or clinically unstable neurologic deficit
Spinal canal compromise causing clinical manifestations of cord, neural foramen, or nerve root compression at the level to be treated
Any physical exam evidence of myelopathy or radiculopathy
Pain based on clinical diagnosis of herniated nucleus pulposus or severe spinal stenosis (progressive weakness or paralysis)
Bedbound prior to incident fracture
Any radiographic evidence of pedicle fracture visible on pre-operative imaging
Spondylolisthesis >Grade 1 at target VB
Any underlying systemic bone disease other than osteoporosis (e.g., osteomalacia, osteogenesis imperfect, Paget's disease, etc.)
A medical contraindication to spinal surgery and/or general anesthesia, such as coagulopathy and/or taking warfarin (Coumadin) or other anticoagulant or anti-aggregate (anti-platelet agents) on regular basis for coagulopathy (with a threshold for normal being INR≤1.5, PTT within lab normal range, and platelet count > 100,000)
Disabling backpain due to causes other than acute fracture
Severe cardiopulmonary deficiencies
Any evidence of alcohol or drug abuse
Uncontrolled psychiatric illness or severe dementia
Involved in medical litigation including workers' compensation