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Proximal Junctional Kyphosis Following Long Instrumented Spinal Fusion: The Effect of Implant Selection (PJK)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01441999
Recruitment Status : Withdrawn (principal investigator decision)
First Posted : September 28, 2011
Last Update Posted : August 2, 2019
University of Michigan
Polaris Spine and Neurosurgery Center
Information provided by (Responsible Party):
Globus Medical Inc

Brief Summary:

The treatment of adult deformity has improved with the development and use of modern segmental instrumentation, including posterior instrumentation. However, the incidence of proximal junctional kyphosis (PJK) caused by the accelerated degeneration of the joint capsules and smaller articular processes in the proximal junctional region has also been noted.

One potential way of decreasing PJK is to decrease the structural rigidity of the construct at the top thereby providing a transition to the non-instrumented spine and allowing for less facet capsule and muscle disruption.

Condition or disease Intervention/treatment Phase
Kyphosis Device: Less rigid rod Device: Rigid Rod Not Applicable

Detailed Description:

While a possible solution to PJK is to reduce structural rigidity at the top of the construct, there is a need to investigate it. In the proposed study, the investigators will compare the rate of proximal junctional kyphosis in patients treated with a stainless steel rod (REVERE Stabilization System) versus those treated with TRANSITION Stabilization System.

Patient outcome measures (Scoliosis Research Society (SRS-22), SF12 and ODI) and radiographic measurements (including lumbar lordosis (L1-S1), adjacent segment kyphosis, thoracolumbar kyphosis (T10-L2), sagittal balance, sacral slope, and pelvic incidence) will be analyzed.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Prevention
Official Title: Proximal Junctional Kyphosis Following Long Instrumented Spinal Fusion: The Effect of Implant Selection
Study Start Date : October 2011
Actual Primary Completion Date : December 2016
Actual Study Completion Date : March 2017

Arm Intervention/treatment
Active Comparator: Less rigid rods
Titanium rods that have a soft, plastic end
Device: Less rigid rod
Titanium rod with semi rigid end

Active Comparator: Rigid Rods
Titanium rods
Device: Rigid Rod
Rigid Titanium rods
Other Name: REVERE

Primary Outcome Measures :
  1. Evidence of Proximal Junction Kyphosis as determined by radiographic measurements during follow up visits [ Time Frame: 2 years ]
    Radiographs will be taken to measure lumbar lordosis, adjacent segment kyphosis, thoracolumbar kyphosis, sagittal balance, Sacral slope and pelvic incidence.

Secondary Outcome Measures :
  1. Patient outcome measures [ Time Frame: 2 years ]
    Forms to be completed at follow up visits will include VAS, SRS 22, SF12, ODI, Patient Satisfaction, Work Status Assessment and Odom's criteria.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Adult patients with degenerative spondylolisthesis with objective evidence of neurologic impairment, kyphosis, and failed previous fusion (pseudoarthrosis) requiring treatment with an instrumented posterior fusion from the thoracolumbar junction (T10-L1) to the sacrum
  • At least 18 years of age and maximum 70 years of age
  • Ability to provide Informed Consent for study participation and patients to return for all follow-up visits

Exclusion Criteria:

  • Presence of systemic or localized infection
  • Previous fusion attempt at the involved level(s)
  • More than three previous open, posterior, lumbar spinal surgical procedures at the involved level(s)
  • Trauma at the levels to be fused
  • Previous documentation of osteopenia or osteomalacia
  • Diagnosis of a condition or requires postoperative medication(s), which may interfere with bony/soft tissue healing
  • Presence of a disease entity or condition which totally precludes possibility of bony fusion (e.g. metastatic cancer, HIV, long term use of steroids, etc.)
  • Immunosuppressive disorder
  • Pregnancy
  • History of alcohol and/or drug abuse
  • Any known allergy to a metal alloy
  • Mentally incompetent or prisoner
  • Currently a participant in another study
  • Preoperative structural deformity in the thoracic spine (kyphosis >60 degrees, Coronal curve >40 degrees)
  • Circumferential fusion above L1

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01441999

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United States, Georgia
Peachtree Neurosurgery
Atlanta, Georgia, United States, 30342
United States, Michigan
Department of Neurosurgery, University of Michigan
Ann Arbor, Michigan, United States, 48109-0338
Department of Orthopedic Surgery, University of Copenhagen, Denmark
Copenhagen, Denmark, 2100
Sponsors and Collaborators
Globus Medical Inc
University of Michigan
Polaris Spine and Neurosurgery Center
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Study Director: Bryan Cunningham, PhD Globus Medical Inc


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Responsible Party: Globus Medical Inc Identifier: NCT01441999     History of Changes
Other Study ID Numbers: RGC11-001
First Posted: September 28, 2011    Key Record Dates
Last Update Posted: August 2, 2019
Last Verified: July 2019
Keywords provided by Globus Medical Inc:
Rigid rods
less rigid rods
prevent kyphosis
long constructs
Additional relevant MeSH terms:
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Spinal Curvatures
Spinal Diseases
Bone Diseases
Musculoskeletal Diseases