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RadiculopathyPhase 3NCT00578812

PCM Cervical Disc System

A Phase 3 study testing Anterior Cervical Discectomy and Fusion (ACDF) and PCM Cervical Disc in people with Radiculopathy and Myelopathy, run by NuVasive at 23 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The PCM Cervical Disc was studied in a prospective, multicenter, randomized FDA-approved investigational device exemption (IDE) clinical trial conducted in the United States to evaluate longitudinal outcomes over 2 years comparatively between the PCM Cervical Disc and anterior cervical discectomy and fusion (ACDF)… Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Radiculopathy, Myelopathy
What is being tested?
Anterior Cervical Discectomy and Fusion (ACDF) and PCM Cervical Disc
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
494 participants
Where
23 sitesUnited States
Study dates
Jan 2005to Aug 2014
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-65 years;
  • Diagnosis of radiculopathy or myelopathy of the cervical spine between C3-4 and C7-T1;
  • Symptomatic at only one level from C3-C4 to C7-T1;
  • Unresponsive to non-operative treatment for six weeks, or has the presence of progressive symptoms or signs of nerve root/spinal cord compression in the face of conservative treatment;
  • Baseline NDI score of ≥30/100;
  • Radiographically determined pathology at level to be treated correlating to primary symptoms, including at least one of the following: decreased disc height, degenerative spondylosis on CT or MRI, or disc herniation;
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  • Appropriate for treatment using an anterior surgical approach, including having no more than one previous anterior surgical approach to the cervical spine;
  • Ability and willingness to comply with follow-up regimen; and
  • Written informed consent given by subject or subject's legally authorized representative.

Who cannot join

  • Infection at the site of surgery;
  • History of, or anticipated treatment for, active systemic infection, including HIV infection or hepatitis C;
  • Prior attempted or completed cervical spine surgery, except (1) laminoforaminotomy with less than one-third facetectomy at any level, or (2) a successful single-level anterior cervical fusion;
  • More than one immobile vertebral level between C1-T1 from any cause, including but not limited to congenital abnormalities, osteoarthritic "spontaneous" fusions, and prior cervical spinal fusions;
  • Previous trauma to the C3-T1 levels resulting in significant bony or disco-ligamentous cervical spine injury;
  • Axial neck pain in the absence of other symptoms of radiculopathy or myelopathy justifying the need for surgical intervention;
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  • Radiographic confirmation of severe facet joint disease or degeneration.
  • Osteoporosis:
  • Severe diabetes mellitus requiring daily insulin management;
  • Active malignancy: a history of any invasive malignancy (except non-melanoma skin cancer), unless the patient has been treated with curative intent and there have been no clinical signs or symptoms of the malignancy for at least 5 years;
  • Tumor as source of symptoms;
  • Symptomatic DDD or significant cervical spondylosis at two or more levels;
  • Known or suspected allergy to cobalt, chromium, molybdenum, titanium, or polyethylene;
  • Severe myelopathy to the extent that the patient is wheelchair bound;
  • Pregnant (verified in patients of childbearing potential by a negative urine pregnancy test when preadmission testing is obtained), or interested in becoming pregnant during the duration of the study;
  • Autoimmune disorders that impact the musculoskeletal system (e.g., lupus, rheumatoid arthritis; ankylosing spondylitis);
  • Spinal axis disease (thoracic or lumbar) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure;
  • Other degenerative joint disease (e.g. shoulder, hip, knee) to the extent that surgical consideration is likely anticipated within 6 months after the cervical randomized procedure;
  • Previous spine surgery within the 6 months preceding the cervical randomized procedure;
  • Current or recent history of substance abuse (drug or alcohol);
  • Morbid obesity, defined as body mass index ("BMI") > 40 or more than 100 lbs. over ideal body weight;
  • Currently using, or planning to use, bone growth stimulators in the cervical spine;
  • Use of any other investigational drug or medical device within the last 30 days prior to surgery
  • Currently a prisoner; or
  • Currently pursuing personal litigation related to the neck or cervical spine injury; however, involvement in worker's compensation related litigation is not a required exclusion.

Trial locations and contacts

23 sites in 1 country.

23 sites in 1 country

United States23 sites
  • NeuroSpine Center of Wisconsin

    Appleton, Wisconsin, 54913

  • Tower Orthopedics

    Beverly Hills, California, 90211

  • Spine Group Beverly Hills

    Beverly Hills, California, 90212

  • Midwest Orthopedic Associates at Rush

    Chicago, Illinois, 60612

  • Chicago Back Institute

    Chicago, Illinois, 60625

  • The Cleveland Clinic

    Cleveland, Ohio, 44195

  • Columbia Orthopedic Research

    Columbia, Missouri, 65201

  • Denver Spine

    Greenwood Village, Colorado, 80111

  • Goodman Campbell Brain and Spine

    Indianapolis, Indiana, 46260

  • Buffalo Spine Surgery

    Lockport, New York, 14094

  • Neuroscience Specialists

    Oklahoma City, Oklahoma, 73120

  • Olympia Othopaedic Associates

    Olympia, Washington, 98502

  • The Rothman Institute

    Philadelphia, Pennsylvania, 19107

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Neurosurgical Associates of San Antonio

    San Antonio, Texas, 78229

  • Wm. Beaumont Hospital

    Southfield, Michigan, 48034

  • Institute for Spine Care

    Syracuse, New York, 13202

  • Madigan Army Medical Center

    Tacoma, Washington, 98431-1100

  • Scott and White Memorial Hospital

    Temple, Texas, 76508

  • Towson Orthopedic Associates

    Towson, Maryland, 21204

  • Walter Reed Army Medical Center

    Washington D.C., District of Columbia, 20307

  • OrthoNeuro

    Westerville, Ohio, 43054

  • Virginia Brain and Spine

    Winchester, Virginia, 22601

Other trials in United States

About this study

Official title: A Prospective, Randomized, Controlled Clinical Investigation Comparing PCM® Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: 2 Year Results From the US IDE Clinical Trial

The PCM Cervical Disc was studied in a prospective, multicenter, randomized FDA-approved investigational device exemption (IDE) clinical trial conducted in the United States to evaluate longitudinal outcomes over 2 years comparatively between the PCM Cervical Disc and anterior cervical discectomy and fusion (ACDF) with allograft and plate. Patients with adjacent or non-adjacent prior fusion were allowed. A total of 416 patients with a degenerated cervical disc at one level from C3-C4 to C7-T1 were enrolled in the clinical trial and 403 were treated. Patients were randomly assigned to be treated either with the PCM Cervical Disc or ACDF.

Read the detailed description

The PCM Cervical Disc was studied in a prospective, multicenter, randomized FDA-approved investigational device exemption (IDE) clinical trial conducted in the United States to evaluate longitudinal outcomes over 2 years comparatively between the PCM Cervical Disc and anterior cervical discectomy and fusion (ACDF) with allograft and plate. Patients with adjacent or non-adjacent prior fusion were allowed. A total of 416 patients with a degenerated cervical disc at one level from C3-C4 to C7-T1 were enrolled in the clinical trial and 403 were treated. Patients were randomly assigned to be treated either with the PCM Cervical Disc or ACDF.

Patients were evaluated before surgery, during the operation, immediately after surgery, and then at 6 weeks, 3 months, 6 months, 12 months and 24 months, and yearly after surgery. The patients were recommended to have a physical therapy program for non-impact exercises and active range of motion exercises after surgery. Patients were also instructed to avoid repetitive cervical flexion and extension bending and lateral bending and rotation for 6 weeks following surgery.

The safety of the PCM Cervical Disc was assessed by comparing the adverse events, any additional surgical procedures, and the neurological outcomes to those in the ACDF control group. The effectiveness of the PCM Cervical Disc was assessed by evaluating patients' pain and function outcomes using a standard questionnaire, the Neck Disability Index (NDI), the severity of neck and arm pain based on a Visual Analog Scale (VAS) assessment, quality of life using a standard questionnaire, the Short Form-36 (SF-36), as well as a patient satisfaction questionnaire compared to the ACDF control group. In addition, the patients were evaluated using radiographic evaluations, including spinal range of motion, spinal disc height, device displacement or migration, spinal fusion status, and heterotopic ossification (abnormal bone formation).

The primary endpoint of the IDE trial was a composite measure termed "overall success," which was evaluated at 24 months postoperatively, and was defined as at least 20% improvement in neck disability index (NDI) from preoperative score; absence of reoperation, revision, or removal; maintenance or improvement in neurological status; and absence of radiographic or major complications during the 24-month follow-up period.

On October 26, 2012, the FDA granted Premarket Approval (PMA) for the PCM Cervical Disc. PCM Cervical Disc is indicated for use in skeletally mature patients for reconstruction of a degenerated cervical disc at one level from C3-C4 to C6-C7 following single-level discectomy for intractable radiculopathy (arm pain and/or a neurological deficit), with or without neck pain, or myelopathy due to a single-level abnormality localized to the disc space, and manifested by at least one of the following conditions confirmed by radiographic imaging (CT, MRI, X-rays): herniated nucleus pulposus, spondylosis (defined by the presence of osteophytes), and/or visible loss of disc height as compared to adjacent levels.

Being tested
Anterior Cervical Discectomy and Fusion (ACDF), PCM Cervical Disc
Medical subject headings
Radiculopathy, Spinal Cord Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Anterior Cervical Discectomy and Fusion (ACDF)Device

    Anterior cervical discectomy and fusion (ACDF) using a cervical plate and bone graft in patients with degenerated cervical discs and neurological symptoms at one level from C3 to T1

  • PCM Cervical DiscDevice

    PCM Cervical Disc replacement in patients with degenerated cervical discs and neurological symptoms at one level from C3 to T1

Study groups in NCT00578812
Study groupRoleWhat they receive
PCM Cervical Disc - InvestigationalExperimentalPCM Cervical Disc replacement at one level from C3 to T1
Receives: Device: PCM Cervical Disc
ACDF - Control GroupActive comparatorAnterior cervical discectomy and fusion (ACDF) at one level from C3 to T1
Receives: Device: Anterior Cervical Discectomy and Fusion (ACDF)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Individual Patient Overall Success

    Individual patient overall success defined as ≥20% improvement in Neck Disability Index (NDI) from preoperative score, no device failures requiring revision, reoperation or removal, and the absence of radiographic or major complications during the 24-month follow-up period.

    Measured: 24 Months

Secondary outcomes (15)
  1. Neck Pain Visual Analog Scale

    Improvement of ≥20mm in neck pain at 24 months compared to baseline.

    Measured: 24 Months

  2. Mean Neck Pain Visual Analog Scale

    Mean neck pain at 24 months on a 0-100 mm Visual Analog Scale (lower value is better).

    Measured: 24 Months

  3. Worst Arm Pain Visual Analog Scale

    Improvement of ≥20mm in worst arm pain at 24 months compared to baseline.

    Measured: 24 Months

  4. Mean Worst Arm Pain Visual Analog Scale

    Mean worst arm pain at 24 months on a 0-100mm Visual Analog Scale (lower value is better).

    Measured: 24 Months

  5. Clinically Significant Improvement on Neck Disability Index (NDI)

    Improvement in NDI of ≥20% at 24 months compared to baseline.

    Measured: 24 Months

  6. Clinically Significant Improvement on Neck Disability Index (NDI)

    Improvement in NDI of ≥15-points at 24 months compared to baseline.

    Measured: 24 Months

  7. Mean Neck Disability Index (NDI)

    Mean NDI at 24 months on a 0-100 scale (lower value is better).

    Measured: 24 Months

  8. Clinically Significant Improvement on SF-36 Physical Component Summary (PCS)

    Improvement of ≥15% on SF-36 PCS at 24 months compared to baseline.

    Measured: 24 Months

  9. Mean SF-36 Physical Component Summary (PCS)

    Mean SF-36 PCS at 24 months on a 0-100 scale (lower value is better).

    Measured: 24 Months

  10. Clinically Significant Improvement on SF-36 Mental Component Summary (MCS)

    Improvement of ≥15% on the SF-36 MCS at 24 months compared to baseline.

    Measured: 24 Months

  11. Mean SF-36 Mental Component Summary (MCS)

    Mean SF-36 MCS at 24 months on a 0-100 scale (lower value is better).

    Measured: 24 Months

  12. Dysphagia for Swallowing

    Mean dysphagia for swallowing at 24 months on a 0-100mm Visual Analog Scale (lower value is better).

    Measured: 24 Months

  13. Patient Satisfaction

    Mean Patient Satisfaction at 24 months on a 0-100 Visual Analog Scale (higher value is better).

    Measured: 24 Months

  14. Nurick's Classification of Disability (Myelopathy)

    Maintenance or improvement in Nurick's Classification from baseline to 24 months. Nurick's classification is a six-point scale, graded 0 to 5. A grade of 0 indicates no symptoms at all, while a grade of 5 is a bed or chair-bound patient. A patient "maintained" if their Nurick classification grade remained the same or "improved" if it decreased from baseline to 24 months.

    Measured: 24 Months

  15. Flexion/Extension Range of Motion at the Operative Level

    Mean flexion/extension range of motion at operative level at 24 months. The operative level is defined as the cervical spinal level at which the surgical procedure was performed.

    Measured: 24 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Dec 2007 (estimated)
  2. Study startJan 2005
  3. Primary completionMar 2010
  4. Study completionAug 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
494 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00578812
Sponsor's protocol ID
G040081
Status last verified
Jun 2015
First submitted
19 Dec 2007
Last updated
7 Jul 2015
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Anterior Cervical Discectomy and Fusion (ACDF) and PCM Cervical Disc in people with Radiculopathy and Myelopathy, run by NuVasive at 23 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Jul 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 23 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 12 Feb 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Individual Patient Overall Success (time frame: 24 Months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jul 2015.

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