Min Implants Max Outcomes Clinical Trial (MIMOCT)

• ClinicalTrials.gov Identifier: NCT01792609
• Recruitment Status: Completed
• First Posted: February 15, 2013
• Last Update Posted: November 1, 2019
• Sponsor: University of Minnesota
• Collaborators: Alfred I. duPont Hospital for Children; Texas Scottish Rite Hospital for Children; Johns Hopkins University; University of Rochester; Washington University School of Medicine; Children's Hospital Colorado; Mayo Clinic; University of Iowa; Norton Leatherman Spine Center; Children's Hospital of Philadelphia; St. Justine's Hospital
• Information provided by (Responsible Party): University of Minnesota

Study Description

Brief Summary:

Objectives Primary objective: Determine if there is a clinically significant difference in percent Cobb curve correction in a low- vs. high-implant density cohort through a prospective randomized controlled trial.

Design and Outcomes Randomized clinical trial of equivalence to test the efficacy and safety of low vs. high implant density instrumentation for spine deformity surgery in AIS patients with Lenke IA curve patterns.

Interventions and Duration Intervention: low-implant density group or high-implant density group. Duration: 2 years. Sample Size and Population Target population: 10 to 17 years old with AIS who will undergo instrumented spinal fusion. Sample size needed (power = 90%) is 174 subjects with 87 in each group.

Condition or disease	Intervention/treatment	Phase
Scoliosis; Adolescent Idiopathic Scoliosis	Procedure: Maximum Number of Screws; Procedure: Minimum Number of Screws	Not Applicable

Detailed Description:

The MIMO Study Group proposes to conduct a prospective randomized controlled trial in order to determine whether a low implant density cohort has equivalent clinical and radiographic results to a high implant density cohort. This study is proposed as a trial of equivalence. The null hypothesis is that significant differences exist in percent major Cobb angle correction between high- and low-implant density cohorts for Lenke 1A curve types, the most common scoliotic curve pattern (73). Consecutive qualifying patients will be screened and enrolled by high-volume spine surgeons at 14 sites and randomized to spinal instrumentation with a low- or high-density screw pattern. Patients will return at 3-months, 1-year, and 2-years for exam, radiographs, and collection of patient-reported outcome scores. The Harms Study Group Foundation will serve as a collaborating organization and will provide database development and management, secure online data collection, centralized radiographic measurements, and data quality control. The University of Minnesota team will lead study design, protocol development, IRB/data use agreement contracts, patient randomization, and statistical analysis, including quarterly data review. Imaging will be obtained either with an EOS system or using a calibration belt during the radiographs, which allows for subsequent with the 3D modeling of the deformity. Six enrolling sites currently have this capability (EOS - Montreal, St. Louis, Iowa, Mayo, DuPont, and San Diego). An additional five sites already have calibration belts - Dallas, New York, Baltimore, Boston, U. of Rochester), and new calibration belts will be fabricated for the additional sites. The Montreal site will supervise collection of radiographic data with 3D capability and assist with troubleshooting and radiographic quality control. Although the study is primarily powered to detect change in percent correction of the major coronal curve, preliminary data will be gathered on axial and sagittal plane correction as well as complications, surgical factors, and patient-reported outcomes.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 200 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Minimize Implants Maximize Outcomes (MIMO) Clinical Trial
• Actual Study Start Date: January 2013
• Actual Primary Completion Date: June 1, 2019
• Actual Study Completion Date: June 1, 2019

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Maximum Number of Screws; Once enrolled and consented, patients with Lenke 1A curves will be randomized to a high- or low-density screw cohort. The high-density pattern will be designated as ≥ 1.8 implants per level fused. The low density pattern will be ≤ 1.4 screws per level fused. At least 75% of the implants must be pedicle screws for both cohorts.	Procedure: Maximum Number of Screws; The tools used for this arm of study are FDA approved with section 510 (k) K122433. These screws are regularly used in all procedures pertaining to Cobb angle correction surgeries outside of the context of this study.; Other Name: Pedicle Screw Spinal System
Active Comparator: Minimum Number of Screws; Once enrolled and consented, patients with Lenke 1A curves will be randomized to a high- or low-density screw cohort. The high-density pattern will be designated as ≥ 1.8 implants per level fused. The low density pattern will be ≤ 1.4 screws per level fused. At least 75% of the implants must be pedicle screws for both cohorts.	Procedure: Minimum Number of Screws; The tools used for this arm of study are FDA approved with section 510 (k) K122433. These screws are regularly used in all procedures pertaining to Cobb angle correction surgeries outside of the context of this study.; Other Name: Pedicle Screw Spinal System

Outcome Measures

Primary Outcome Measures :

1. Change in Cobb Angle [ Time Frame: pre-surgery ranging 1 year to 1 month and peri surgery at about 3-months, 1-year, and 2-year postoperative ]
   Radiographic, surgical, and patient-reported data will be gathered and analyzed to observe changes between time points. All radiographs will be taken with 3D analysis capability, either with a calibration belt using standard radiograph techniques or with an EOS imaging system. This will allow for additional detailed correction measures, such as change in spinal rotation (orientation of the planes of maximum curvature) and detailed coronal, sagittal and transverse plane measures. Bending films will be taken according to institutional protocol. The SRS-30, SAQ, and EQ5D will be collected at all clinical visits. Study questions will be aligned as much as possible with other prospective scoliosis protocols so as to minimize patient and surgeon response burden. The study protocol requires no additional visits or radiographs beyond standard of care.

Secondary Outcome Measures :

1. Blood Loss [ Time Frame: During surgery, 1 time occurence ]
   Blood loss amount that occured during the surgical procedure.
2. Operative Time [ Time Frame: 1 time measurement, occurs at surgery ]
   Length of time required to complete surgical procedure in either arm of the study (highest number or lowest number of screws).
3. 3D parameter correction [ Time Frame: collected during surgical procedure ]
   Surgeon reported measure of screw manipulation during the surgery.

Eligibility Criteria

• Ages Eligible for Study: 10 Years to 18 Years (Child, Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Patients aged ≥10 and ≤ 18 years
• Male or Female
• Diagnosis of idiopathic scoliosis for which surgery is recommended to prevent the curvature or to correct trunk disfigurement Lenke 1A curve pattern
• Curve cobb of 45° to 65°
• T5-T12 kyphosis measuring 0° to 40°
• Spina bifida Oculta is permitted
• Spondylolisthesis and Spondylolysis are permitted, as long as non- operative

Exclusion Criteria:

• Prior spinal surgery
• MRI abnormalities (including >4mm of Syrinx and/or Chiari malformation)
• Neuromuscular or other serious co-morbidities
• Thoracogenic or cardiogenic scoliosis
• Associated syndrome or developmental delay
• Unable or unwilling to firmly commit to returning for required follow-up

Contacts and Locations

Locations

United States, Colorado

Children's Hospital Colorado

Aurora, Colorado, United States, 80045

United States, Delaware

Nemours/ Alfred I. duPont Hospital for Children

Wilmington, Delaware, United States, 19803

United States, District of Columbia

Children's Research Institute

Washington, District of Columbia, United States, 20010-2916

United States, Florida

University of Florida

Gainesville, Florida, United States, 32611

United States, Georgia

Emory University

Atlanta, Georgia, United States, 30329

United States, Iowa

University of Iowa

Iowa City, Iowa, United States, 52242

United States, Kentucky

Norton Leatherman Spine Center

Louisville, Kentucky, United States, 40207

United States, Maryland

Johns Hopkins University

Baltimore, Maryland, United States, 21205

United States, Minnesota

University of Minnesota

Minneapolis, Minnesota, United States, 55454

Mayo Clinic

Rochester, Minnesota, United States, 55905

United States, Missouri

The Washington University in St. Louis

Saint Louis, Missouri, United States, 63110

United States, New York

University of Rochester

Rochester, New York, United States, 14618

United States, Texas

Texas Scottish Rite Hospital for Children

Dallas, Texas, United States, 75219

Canada, Quebec

Centre Hospitalier Universitaire Sainte-Justine

Montreal, Quebec, Canada, H3T1C5

Sponsors and Collaborators

University of Minnesota

Alfred I. duPont Hospital for Children

Texas Scottish Rite Hospital for Children

Johns Hopkins University

University of Rochester

Washington University School of Medicine

Children's Hospital Colorado

Mayo Clinic

University of Iowa

Norton Leatherman Spine Center

Children's Hospital of Philadelphia

St. Justine's Hospital

Investigators

• Principal Investigator: David W Polly, MD; University of Minnesota

More Information

• Responsible Party: University of Minnesota
• ClinicalTrials.gov Identifier: NCT01792609
• Other Study ID Numbers: 1208M18202
• First Posted: February 15, 2013
• Last Update Posted: November 1, 2019
• Last Verified: October 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Keywords provided by University of Minnesota:

Scoliosis; Cobb Angle; Screw Density; Outcomes Measures

Additional relevant MeSH terms:

Scoliosis; Spinal Curvatures; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases