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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03194568
Other study ID # 17-013694
Secondary ID
Status Active, not recruiting
Phase N/A
First received
Last updated
Start date July 12, 2017
Est. completion date May 2023

Study information

Verified date March 2022
Source Children's Hospital of Philadelphia
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study will assess whether Anterior Vertebral Tethering is a safe and feasible method of anterior approach surgery for spinal deformity in pediatric idiopathic scoliosis.


Description:

Scoliosis is a condition in which the spine is deformed by a curvature in the coronal plane. It is generally associated with a twisting (axial plane) deformity as well. It can have a variety of underlying etiologies and the etiology is used to classify the types of scoliosis. Idiopathic scoliosis is sub-classified in two ways: by age of onset and by magnitude of deformity. Curves between 10 and 25 degrees are considered mild. Curves between 25 and 50 degrees are classified as moderate. Curves greater than 50 degrees are termed severe. The current standard of care for moderate scoliosis in patients with remaining growth is to utilize a thoracolumbosacral orthosis (TLSO brace) to prevent progression of deformity. The scientific evidence has supported the efficacy of this intervention in avoiding progression of the Cobb angle to 50 degrees or more. If treated with a TLSO brace, many idiopathic scoliosis patients would conceivably be subjected to years of brace wear and the cost and psychological factors inherent therein. Additional downsides of brace treatment include the potentially negative psychosocial impact of wearing an external sign of deformity during adolescence, a key period of emotional development. Prior research has identified negative psychosocial effects related to wearing a brace in children. Recent evidence has suggested that certain curve patterns will likely progress to 50 degrees or more, despite treatment with a TLSO brace. Sanders, et al. demonstrated a correlation of Cobb angle (greater than 35 degrees) and skeletal maturity (bone age 4 or less) to the risk of progression to 50 degrees or more, despite TLSO bracing. The evidence supports that the current practice of TLSO bracing is not an effective treatment to avoid progression to 50 degrees in these patients. It is on this population (thoracic Cobb angle greater than 35 degrees, bone age of 4 or less) that we intend to test the safety and feasibility of Anterior Vertebral Body Tethering to avoid curve progression to 50 degrees. The study intervention is surgical orthopedic implantation of the Anterior Vertebral Tether Device, by way of thoracoscopic surgery under general anesthesia. The primary outcome measures include assessments of safety of the insertion procedure and of the device, as well as the secondary measure of feasibility by determining the ability to successfully implant the investigational device.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 20
Est. completion date May 2023
Est. primary completion date January 26, 2022
Accepts healthy volunteers No
Gender All
Age group 8 Years to 16 Years
Eligibility Inclusion Criteria: 1. Males or females age 8 to 16 years old at time of enrollment (inclusive) 2. Diagnosis of idiopathic scoliosis 3. Sanders bone age of less than or equal to 4 4. Thoracic curve of greater than or equal to 35 degrees and less than or equal to 60 degrees 5. Lumbar curve less than 35 degrees 6. Patient has already been identified for and recommended to have surgical intervention 7. Spina bifida occulta is permitted 8. Spondylolysis or Spondylolisthesis is permitted, as long as it is non-operative, the subject has not had any previous surgery for this, and no surgery is planned in the future Exclusion Criteria: 1. Pregnancy (current) 2. Prior spinal or chest surgery 3. MRI abnormalities (including syrinx greater than 4mm, Chiari malformation, or tethered cord) 4. Neuromuscular, thoracogenic, cardiogenic scoliosis, or any other non-idiopathic scoliosis 5. Associated syndrome, including Marfan syndrome or neurofibromatosis 6. Sanders bone age greater than 4 7. Thoracic curve less than 35 degrees or greater than 60 degrees 8. Lumbar curve greater than or equal to 35 degrees 9. Unable or unwilling to firmly commit to returning for required follow-up visits 10. Investigator judgement that the subject/family may not be a candidate for the intervention

Study Design


Related Conditions & MeSH terms


Intervention

Device:
Anterior Vertebral Tether
Vertebral body tethering through anterior thoracoscopic approach under general anesthesia and fluoroscopic guidance.

Locations

Country Name City State
United States The Children's Hospital of Philadelphia Philadelphia Pennsylvania

Sponsors (1)

Lead Sponsor Collaborator
Patrick Cahill, MD

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Incidence of Treatment-Emergent Adverse Events Intra-operative and post-intervention medical events or signs and symptoms of complications arising after the start of study intervention will be captured. The event description, date of onset, end date, severity, and outcome will be documented. The frequencies, type, body system, severity, and relationship to the study intervention will also be summarized. A distinction will be made between those events which are "device-related" and "non device-related". 2 years after last subject's device implantation
Secondary Comparison of Pre-Operative and Post-Operative Cobb Angle The exploratory therapeutic endpoint used for feasibility will be change in post-operative Cobb angle compared to pre-operative Cobb angle, measured on coronal radiograph of the spine. 2 years after last subject's device implantation
Secondary Comparison of Pre-Operative and Post-Operative SRS 30 Scores The SRS 30 questionnaire will be administered at pre-operative and post-operative time points. The results of the questionnaire will be used for pre-operative and post-operative comparative analysis of device related outcomes. 2 years after last subject's device implantation
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