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Spinal Stenosis LumbarNCT03105167

Cortical Bone Trajectory Screws vs. Traditional Pedicle Screws Fixation

A study testing cortical bone trajectory screws and pedicle screws in people with Spinal Stenosis Lumbar and Lumbar Disc Herniation, run by Second Affiliated Hospital of Wenzhou Medical University at 1 site in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Transforaminal lumbar interbody fusion (TLIF) had been favorable for effectively decrease pain and disability in specific spinal disorders; however, there has been concern regarding pedicle screw placement during TLIF surgery. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
What is being tested?
cortical bone trajectory screws and pedicle screws
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
108 participants
Where
1 siteChina
Study dates
7 May 2018to 13 Dec 2021
Phase
Interventional
Are there results?
None posted in the registry

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 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Age of at least 18 years;
  • All of participants will be informed consent;
  • Chronic low back pain (visual analogue scale at least 3 out of 10 at rest and at least 5 out of 10 under physical strain) after having failed conservative treatment for 6 months;
  • Single-segment lower lumbar vertebral disease (Including lumbar spinal cannal stenosis, foraminal stenosis, segmental instability, lumbar disc herniation, and painful disc degeneration (back disc);

Who cannot join

  • Serious deformity of lumbar vertebrae;
  • Dysplasia of lumbar pedicle or vertebral laminar;
  • Obvious osteoporosis of lumbar vertebrae;
  • Metabolic bone diseases such as osteomalacia or Paget's disease;
  • Spondylolisthesis > grade 2 (Meyerding);
  • Caudaequina injury or severe radiculopathy;
Show all 11Show fewer
  • Post inflammatory instability of the vertebral spine;
  • Body mass index > 30;
  • Immunologic diseases or Metabolic syndrome;
  • Therapy with systemic corticosteroids or immunosuppressants;
  • Current using Coumadin (or Warfarin) or Heparin therapy for more than 6 months at the time of operation.

Trial locations and contacts

1 site in 1 country.

China1 site, 1 recruiting
  • The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University

    Wenzhou, Zhejiang, 325000

    TING LI, 057788002888, feclinicalresearch@163.com

    WENFEI NI

    Recruiting

Other trials in China

About this study

Official title: Transforaminal Lumbar Interbody Fusion With Cortical Bone Trajectory Screws vs. Traditional Pedicle Screws Fixation: a Multicentre Randomised Controlled Trial

Transforaminal lumbar interbody fusion (TLIF) had been favorable for effectively decrease pain and disability in specific spinal disorders; however, there has been concern regarding pedicle screw placement during TLIF surgery. Recently, several biomechanical studies had demonstrated that CBT technique achieves screw purchase and strength equivalent to or greater than the traditional method. Furthermore, Only 1 report examined the surgical outcomes of TLIF with CBT screws fixation compared with TLIF using traditional pedicle screws fixation. TLIF with CBT screws fixation may be effective for specific spinal disorders, but the evidence supporting this possibility is still limited.

Read the detailed description

Methods and analysis: Blinded Randomized Controlled Trial (RCT) will be conducted. A total of 108 participants will be randomly allocated to either a CBT-TLIF group or a PS-TLIF group at a ratio of 1:1. The primary clinical outcome measures are: change in back and lower limb pain with Visual analogue scale (VAS) and change in quality adjusted life years (QALY) will be assessed by EQ-5D-5L. Measurements will be carried out at five fixed time points (pre-operatively and at 3, 6, 12 and 24 months).

Ethics and dissemination: The study had been reviewed and approved by the ethics committee of the Second affiliated hospital of the Wenzhou Medical University, Wenzhou, China(batch:2017-03). The results will be presented in peer-reviewed journals and related website within 2 years after the last operation.

Being tested
cortical bone trajectory screws, pedicle screws
Keywords
CBT, RCT, TLIF
Medical subject headings
Intervertebral Disc Displacement, Intervertebral Disc Degeneration

What participants receive

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

  • cortical bone trajectory screwsProcedure or surgery

    cortical bone trajectory screws fixation takes the place of traditional pedicle screws fixation will be used in transforaminal lumbar interbody fusion.

  • pedicle screwsProcedure or surgery

    traditional pedicle screws fixation will be used in transforaminal lumbar interbody fusion.

Study groups in NCT03105167
Study groupRoleWhat they receive
CBT-TLIF groupExperimentalPatients who are randomised to the CBT-TLIF group will have cortical bone trajectory screws instead of pedicle screws During the opreation. After preventive use of antibliotics,A small skin incision was made at the fused segment, an entry point for insertion of the CBT screws was drilled in the junction of the center of the superior articular process and 1 mm inferior to the inferior border of the transverse process according to Matsukawa et al.A straight probe was used to create a trajectory for the CBT screws from the entry point to the opposite corner of the pedicle and vertebral body under anteroposterior fluoroscopic guidance.nilateral facetectomy is performed to gain access to the intervertebral disc.Afterwards, interbody fusion was performed.Device: CBT screws.
Receives: Procedure: cortical bone trajectory screws
PS-TLIF groupExperimentalPatients who are randomised to the PS-TLIF group will have pedicle screws During the opreation. A posterior midline incision, about 6 cm, was performed at the level of interest level under fluoroscopic guidance. Pedicle screws were inserted into the vertebral body by using freehand, and the inferior and superior articular processes and part pf the lamina were removed by using an osteotome. To expose the lateral border of the ipsilateral nerve root, the ligamentum flavum was removed. Afterwards, interbody fusion was performed.Device:traditional pedicle screws.
Receives: Procedure: pedicle screws

What is being measured

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

  1. Visual analogue scale(VAS)

    pain score

    Measured: up to 36 months

Secondary outcomes (3)
  1. Oswestry Disability Index (ODI)

    The Oswestry Disability Index pain score

    Measured: up to 48 months

  2. Symptomatic adjacent-segment disease (SASD)

    Symptomatic adjacent-segment disease rate

    Measured: up to 48 months

  3. Japanese Orthopedic Association (JOA)

    Japanese Orthopedic Association score

    Measured: up to 48 months

Timeline

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

  1. First posted7 Apr 2017
  2. Study start7 May 2018
  3. Primary completion13 Dec 2020 (estimated)
  4. Study completion13 Dec 2021 (estimated)

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
108 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03105167
Sponsor's protocol ID
SAHoWMU-CR2017-08-106
Status last verified
Jul 2018
First submitted
28 Mar 2017
Last updated
27 Jul 2018
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All of the patients' outcomes (without patients' personal information) will be public shared within 2 years after clinical trial complete.

Publications

  • Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC 3rd, Wang J, Walters BC, Hadley MN; American Association of Neurological Surgeons/Congress of Neurological Surgeons. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2005 Jun;2(6):673-8. doi: 10.3171/spi.2005.2.6.0673.

    PubMed 16028736
  • Brayda-Bruno M, Tibiletti M, Ito K, Fairbank J, Galbusera F, Zerbi A, Roberts S, Wachtel E, Merkher Y, Sivan SS. Advances in the diagnosis of degenerated lumbar discs and their possible clinical application. Eur Spine J. 2014 Jun;23 Suppl 3:S315-23. doi: 10.1007/s00586-013-2960-9. Epub 2013 Aug 27.

    PubMed 23978994
  • Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J. 2014 Aug;8(4):521-30. doi: 10.4184/asj.2014.8.4.521. Epub 2014 Aug 19.

    PubMed 25187873
  • Harms JG, Jeszenszky D. Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Oper Orthop Traumatol. 1998 Jun;10(2):90-102. doi: 10.1007/s00064-006-0112-7. No abstract available. German.

    PubMed 17332991
  • Rouben D, Casnellie M, Ferguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech. 2011 Jul;24(5):288-96. doi: 10.1097/BSD.0b013e3181f9a60a.

    PubMed 20975594
  • Santoni BG, Hynes RA, McGilvray KC, Rodriguez-Canessa G, Lyons AS, Henson MA, Womack WJ, Puttlitz CM. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009 May;9(5):366-73. doi: 10.1016/j.spinee.2008.07.008. Epub 2008 Sep 14.

    PubMed 18790684
  • Matsukawa K, Yato Y, Kato T, Imabayashi H, Asazuma T, Nemoto K. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine (Phila Pa 1976). 2014 Feb 15;39(4):E240-5. doi: 10.1097/BRS.0000000000000116.

    PubMed 24253778
  • Baluch DA, Patel AA, Lullo B, Havey RM, Voronov LI, Nguyen NL, Carandang G, Ghanayem AJ, Patwardhan AG. Effect of physiological loads on cortical and traditional pedicle screw fixation. Spine (Phila Pa 1976). 2014 Oct 15;39(22):E1297-302. doi: 10.1097/BRS.0000000000000553.

    PubMed 25099320
  • Perez-Orribo L, Kalb S, Reyes PM, Chang SW, Crawford NR. Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine (Phila Pa 1976). 2013 Apr 15;38(8):635-41. doi: 10.1097/BRS.0b013e318279a95e.

    PubMed 23104197
  • Matsukawa K, Kato T, Yato Y, Sasao H, Imabayashi H, Hosogane N, Asazuma T, Chiba K. Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique. Spine (Phila Pa 1976). 2016 Jul 15;41(14):E851-E856. doi: 10.1097/BRS.0000000000001459.

    PubMed 26796712
  • Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Kudo D, Shimada Y. Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory. Asian Spine J. 2015 Jun;9(3):440-8. doi: 10.4184/asj.2015.9.3.440. Epub 2015 Jun 8.

    PubMed 26097661
  • Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013 Jan 8;346:e7586. doi: 10.1136/bmj.e7586.

    PubMed 23303884
  • Matsukawa K, Yato Y, Nemoto O, Imabayashi H, Asazuma T, Nemoto K. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech. 2013 Aug;26(6):E248-53. doi: 10.1097/BSD.0b013e318288ac39.

    PubMed 23429319
  • Dixon JS, Bird HA. Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis. 1981 Feb;40(1):87-9. doi: 10.1136/ard.40.1.87.

    PubMed 7469530
  • M Versteegh M, M Vermeulen K, M A A Evers S, de Wit GA, Prenger R, A Stolk E. Dutch Tariff for the Five-Level Version of EQ-5D. Value Health. 2016 Jun;19(4):343-52. doi: 10.1016/j.jval.2016.01.003. Epub 2016 Mar 30.

    PubMed 27325326

Questions about this trial

What is this clinical trial studying?

A study testing cortical bone trajectory screws and pedicle screws in people with Spinal Stenosis Lumbar and Lumbar Disc Herniation, run by Second Affiliated Hospital of Wenzhou Medical University at 1 site in China.

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 4 inclusion and 11 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: status not confirmed, as of the sponsor's last update on 27 Jul 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. 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.

Are results available for this study?

Results are not available in the source record.

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

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Visual analogue scale(VAS) (time frame: up to 36 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03105167, which also lists 21 linked publications.

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 27 Jul 2018.

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