Lumbar Spinal Stenosis Clinical Trial
Official title:
A Prospective, Multi-Center, Randomized Concurrently Controlled Trial to Evaluate the Safety and Effectiveness of the Altum® Pedicle Osteotomy System for Use in Lumbar Spinal Stenosis
This is a pivotal Randomized Clinical trial to compare the safety and effectiveness of the Pedicle Lengthening Osteotomy Procedure with implantation of the Altum® Device to open surgical decompression and Transforaminal Lumbar Interbody Fusion (TLIF) in patients with symptomatic, one or two level lumbar spinal stenosis (LSS) and one level grade I degenerative spondylolisthesis requiring surgical treatment.
LSS is a narrowing of the spinal canal and/or the intervertebral foramina by bony spurs or
soft tissues that decrease space for the neural elements resulting in compression of the
nerve roots or spinal cord in the lumbar region of the spine. LSS can cause low back pain,
weakness, numbness, and pain and loss of sensation in the buttocks and legs. In most cases
the symptoms improve when the patient is sitting or leaning forward, due to the flexed
position of the vertebra which leads to reduced impingement of the neural tissue. In
addition, many patients with LSS complain of pain when standing and walking referred to as
neurogenic intermittent claudication (NIC). Nonsurgical management is well-established as the
first-line treatment approach for LSS patients with mild to moderate symptoms. It typically
involves the prescription of modified physical activity, physiotherapy, anti-inflammatory
drugs, epidural steroid injections, use of a lumbar corset or some combination thereof.
Surgical treatment is reserved for patients who do not obtain adequate relief of symptoms by
conservative management. The goal of surgical treatment for LSS is to relieve the compression
of the spinal nerves in the spinal canal or neural foramina. Such decompressive surgery
generally involves laminectomy, laminotomy, foraminotomy, partial facetectomy or some
combination thereof. Decompressive surgery in subjects with LSS and spondylolisthesis
commonly requires fusion to stabilize the spondylolisthesis. The most commonly performed
lumbar fusion for patient's with the combination of LSS and spondylolisthesis is a
Transforaminal Lumbar Interbody Fusion (TLIF) which involves stabilizing the motion segment
by placing pedicle screws, rods and an interbody fusion cage. Autograft or allograft bone are
commonly used to bring about fusion or a bridging of bone across the intervertebral joint.
The Altum® Pedicle Osteotomy System contains the implants and instruments required to perform
the pedicle lengthening osteotomy procedure for the treatment of LSS. The Altum® implant is
an expandable bone screw that is available in a variety of sizes (7.5 mm, 8.5 mm and 9.5 mm).
Altum® instruments are manufactured from IXEF PARA GS-1022 GY/51, medical grade titanium
alloy (Ti 6AL-4V ELI ASTM F-136), and medical grade stainless steel (17-4 ASTM F899).
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