Intervertebral DXM Gel Injection in Adults With Painful Lumbar Degenerative Disc Disease

Not Applicable

• Conditions: Lumbar Disc Disease; Intervertebral Disc Degeneration; Degenerative Disc Disease; Chronic Lower Back Pain; Discogenic Pain; Lumbar Disc Pain; Lumbar Disc Degeneration
• Interventions: Device: Double Crosslink Microgel

• Registration Number: NCT04727385
• Lead Sponsor: Gelmetix

Brief Summary

The purpose of this study is to assess the safety and the efficacy of an hydrogel (double cross-link microgel - DXM) injection into the intervertebral disc (IVD) space in patients with painful lumbar degenerative disc disease (DDD) over 24 to 48 weeks.

Detailed Description

After being informed of the study and the potential risks, all patients matching the eligibility criteria and who have given their written consent will undergo a gel injection at day 0 after a period of screening of up to 14 days.

Then, they will be followed-up for a variable period according to the cohort :

* first cohort of 5 patients with only one disc to be treated will be followed during 48 weeks,

* second cohort of 5 patients with 2 discs to be treated will be followed during 36 weeks,

* third cohort of 10 patients with 1 or 2 discs to be treated will be followed during 24 weeks.

Study Timeline

• Study Start: 2020-09-15
• Status Verified: 2021-01
• Study First Submitted: 2021-01-13
• Study First Submitted QC: 2021-01-22
• Last Update Submitted: 2021-01-22
• Study First Posted: 2021-01-27
• Last Update Posted: 2021-01-27
• Primary Completion: 2021-10
• Study Completion: 2021-10

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

1. Male or female patient aged between 18 and 55 (inclusive)

2. Discogenic low back pain, confirmed by a history of Low Back Pain, with a minimum of 3 months of continuous pain or 6 months of acute episodes of pain despite the conservative treatment including painkillers and physiotherapy

3. Oswestry Disability Index (ODI) ≥ 30% and ≤ 60%,

4. Painful disc(s) between L1 and S1 represented

   1. For cohort 1L: at a single disc level
   2. For cohort 2L: at 2 disc levels
   3. For cohort 1-2L: at 1 or 2 disc levels

5. Patients with a Zung depression score ≤ 49, Note: Patients with a Zung depression score between ≥ 50 and ≤ 64 may be included if deemed suitable for trial inclusion by the investigator

6. Partial dehydration (grey disc) confirmed by MRI, grade II/III Pfirrmann classification

   Note:

   • Pfirrmann Grade I lesions are not contra-indications to recruitment, but can never be the target of any intervention in this trial. Patients featuring grade I disc(s) in conjunction with a grade II/III meet the inclusion criteria for his(her) disc Grade II/III disc to be treated
   • Pfirrmann Grade IV and V disc lesions are absolute contra-indications for inclusion

7. Female patients of childbearing potential must have a negative urine pregnancy test at screening and use an effective birth control during the follow up period after the injection procedure

8. Patients who are willing and capable of understanding the investigator's explanations, following his instructions and adhering to the follow-up visits according to the study protocol, including a willingness and ability to undergo MRI scanning,

9. Patient giving informed consent to take part in the study

Exclusion Criteria

1. Averted nerve root pain and potential root compression Note: Referred leg pain authorised

2. Presence of posterior bone spurs (osteophytes)

3. Partial or total Modic signal grade 1 at the considered disc level

4. Patients with active systemic infection or infection localized to the site of the proposed implantation.

5. Any conditions not described in the indications for use.

6. Any mental conditions or neuromuscular disease that may generate an unacceptable risk of failure or postoperative complication.

7. Patients with existing disc herniation at the considered level and on adjacent discs

8. Endplate disease, defect or weakness, e.g. Schmorl nodule

9. Vertebral bone abnormalities with active angioma

10. Disc collapse ≥ 15% when disc height is compared to the height of the upper adjacent disc

11. One lumbar disc rated grade IV or V on the Pfirrmann classification

12. Imaging showing facet arthrosis

13. Lytic spondylolisthesis

14. Degenerative spondylolisthesis grade > grade I Meyerding

15. Congenital or idiopathic deformities of the spine (e.g. Scoliosis >20° Cobb or Kyphosis)

16. Old or acute vertebral fractures in the lumbar spine

17. Patients with any prior spine procedure in the lumbar spine

18. Any skin disease or inadequate tissue coverage at the site of the injection

19. Any medical or surgical conditions that could preclude the potential benefit of disc injection must be carefully analysed before the procedure, such as congenital abnormalities, immunosuppressive disease, elevation of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) concentration not explained by other diseases, elevation of white blood cell (WBC) count, or marked left shift in the WBC differential count, should be carefully taken into consideration prior to the surgical procedure.

    Note: These contra-indications can be relative or absolute and must be taken into account by the physician when making his decision. The above list is not exhaustive.

20. Tumours with any metastatic potential, or known metastases, in any part of the body

21. Known infection with HIV or Hepatitis B, C or E

22. Patient that has received or is seeking employee compensation

23. Zung depression score ≥ 65

24. Substance abuse or dependency (pharmaceuticals, drugs, alcohol)

25. Disabling obesity (BMI > 35kg/m²)

26. History of chemical dependency (e.g. illicit drugs, or opiates) or significant emotional or psychosocial disturbance which may have an effect on treatment outcome

27. Patients who are pregnant, breast feeding or planning pregnancy during the study

28. Anticoagulation (beyond low level prophylactic doses of single anti-platelet agents)

29. Inability to undertake or known contra-indications to MRI scanning

30. Known hypersensitivity to barium sulphate

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
single-arm of 3 cohorts	Double Crosslink Microgel	These patients will be sequentially recruited in 3 cohorts : * One disc level cohort: 5 patients with only one disc to be treated; First enrolled cohort with 48 weeks of follow-up (9 visits V1-V9) * Two disc level cohort: 5 patients with 2 discs to be treated; Second enrolled cohort with 36 weeks of follow-up (8 visits, same visits except for V9) * One or two disc level cohort: 10 patients with 1 or 2 discs to be treated; Third enrolled cohort with 24 weeks of follow-up (6 visits, V1 to 7 except for V4)

Primary Outcome Measures

Name	Time	Method
The number of patients with at least one adverse event (AE) or serious adverse event (SAE)	Between screening visit and 24 weeks (measured at each visits)	An adverse event (AE) is any untoward medical occurrence in a patient exposed to a medical device and which does not necessarily have a causal relationship with this medical device.; An AE can therefore be any unintended disease or injury or clinical signs (including an abnormal laboratory finding) in subjects, users or other persons whether or not considered related to the investigational medical device.; A serious adverse event (SAE) is defined as an AE that: * led to a death, injury or permanent impairment to a body structure or a body function; * led to a serious deterioration in health of the subject, that either resulted in: a life-threatening illness or injury, or a permanent impairment of a body structure or a body function, or in-patient hospitalization or prolongation of existing hospitalization, or in medical or surgical intervention to prevent life threatening illness; * led to foetal distress, foetal death or a congenital abnormality or birth defect.
The number of adverse events (AEs) or serious adverse event (SAEs)	Between screening visit and 24 weeks (measured at each visits)	An adverse event (AE) is any untoward medical occurrence in a patient exposed to a medical device and which does not necessarily have a causal relationship with this medical device.; An AE can therefore be any unintended disease or injury or clinical signs (including an abnormal laboratory finding) in subjects, users or other persons whether or not considered related to the investigational medical device.; A serious adverse event (SAE) is defined as an AE that: * led to a death, injury or permanent impairment to a body structure or a body function; * led to a serious deterioration in health of the subject, that either resulted in: a life-threatening illness or injury, or a permanent impairment of a body structure or a body function, or in-patient hospitalization or prolongation of existing hospitalization, or in medical or surgical intervention to prevent life threatening illness; * led to foetal distress, foetal death or a congenital abnormality or birth defect.
The number of patients with neurological changes during the follow-up period according to the evaluation of nerve root pain, sensory deficit and motor deficit	Between screening visit and 24 weeks (measured at each visits)	The neurological evaluation will look more specifically for: * The presence or absence of nerve root pain and its localisation (i.e. Lassegue test); * The presence of deferred pain in the leg without deficit; * The presence or absence of sensory deficit and its localisation; * The presence or absence of motor deficit and its classification from grade 1 to 5 (0 - Total Paralysis, 1 - Palpable or Visible, 2 - Active Movement, gravity eliminated, 3 - Active Movement, against gravity, Contraction, 4 - Active Movement, against some resistance, 5 - Active Movement, against full resistance (normal muscular force))
The change of the water content of the nucleus measured in milliseconds on the MRI during the follow-up period	Between screening visit and 24 weeks (measured at each visits)	The Magnetic resonance imaging (MRI) will allow the observation.
The modifications observed after the injection in the adjacent tissues of the injected nucleus	Between screening visit and 24 weeks (measured at each visits)	The Magnetic resonance imaging (MRI) will allow the observation of the corresponding adjacent tissues: * Annulus fibrosus; * Endplates; * Facets
The change of the intervertebral height in millimetres of the injected disc	Between screening visit and 24 weeks (measured at each visits)	The Magnetic resonance imaging (MRI) will allow the observation.
The change of the DXM gel position in relation to posterior and anterior limit of the annulus fibrosus and vertebral disc end-plates	Between screening visit and 24 weeks (measured at each visits)	The Magnetic resonance imaging (MRI) will allow the observation.

Secondary Outcome Measures

Name	Time	Method
The change of the intervertebral height in millimetres of the injected disc	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	The Magnetic resonance imaging (MRI) will allow the observation.
The change of the DXM gel position in relation to posterior and anterior limit of the annulus fibrosus and vertebral disc end-plates	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	The Magnetic resonance imaging (MRI) will allow the observation.
Oswestry disability index (ODI)	Measured and compared to baseline at the different time points of the flowchart according to the cohort (over 24 to 48 weeks)	The ODI score is based on a self-completed questionnaire of 10 items to measure a patient's permanent functional disability. It is a well-recognised, gold standard orthopaedic score devised in 1980 and which still remains the best and most reliable measure of the overall impact of spinal disease associated with low back pain and any interventions patients may receive. It has been repeatedly used for natural history studies, cohort studies, and for many device and surgery interventions. It is reproducible, reliable and responsive to therapeutic interventions.
Visual analogue scale (VAS) self-assessment	Measured and compared to baseline at the different time points of the flowchart according to the cohort (over 24 to 48 weeks)	The visual analogue self-assessment scale is an evaluation performed by the patient to specify his level of pain on a scale of 'no pain' to 'extreme pain'.; During the site visit, the VAS is to be filled on-site by the patient and collected by the site staff.
Working status	measured and compared to baseline at the different time points of the flowchart according to the cohort (over 24 to 48 weeks)	The working status will be collected by interviewing the patient about his/her work activity.
The number of patients with at least one adverse event (AE) or serious adverse event (SAE)	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	An adverse event (AE) is any untoward medical occurrence in a patient exposed to a medical device and which does not necessarily have a causal relationship with this medical device.; An AE can therefore be any unintended disease or injury or clinical signs (including an abnormal laboratory finding) in subjects, users or other persons whether or not considered related to the investigational medical device.; A serious adverse event (SAE) is defined as an AE that: * led to a death, injury or permanent impairment to a body structure or a body function; * led to a serious deterioration in health of the subject, that either resulted in: a life-threatening illness or injury, or a permanent impairment of a body structure or a body function, or in-patient hospitalization or prolongation of existing hospitalization, or in medical or surgical intervention to prevent life threatening illness; * led to foetal distress, foetal death or a congenital abnormality or birth defect.
The number of adverse events (AEs) or serious adverse event (SAEs)	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	An adverse event (AE) is any untoward medical occurrence in a patient exposed to a medical device and which does not necessarily have a causal relationship with this medical device.; An AE can therefore be any unintended disease or injury or clinical signs (including an abnormal laboratory finding) in subjects, users or other persons whether or not considered related to the investigational medical device.; A serious adverse event (SAE) is defined as an AE that: * led to a death, injury or permanent impairment to a body structure or a body function; * led to a serious deterioration in health of the subject, that either resulted in: a life-threatening illness or injury, or a permanent impairment of a body structure or a body function, or in-patient hospitalization or prolongation of existing hospitalization, or in medical or surgical intervention to prevent life threatening illness; * led to foetal distress, foetal death or a congenital abnormality or birth defect.
The number of patients with neurological changes during the follow-up period according to the evaluation of nerve root pain, sensory deficit and motor deficit	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	The neurological evaluation will look more specifically for: * The presence or absence of nerve root pain and its localisation (i.e. Lassegue test); * The presence of deferred pain in the leg without deficit; * The presence or absence of sensory deficit and its localisation; * The presence or absence of motor deficit and its classification from grade 1 to 5 (0 - Total Paralysis, 1 - Palpable or Visible, 2 - Active Movement, gravity eliminated, 3 - Active Movement, against gravity, Contraction, 4 - Active Movement, against some resistance, 5 - Active Movement, against full resistance (normal muscular force))
The change of the water content of the nucleus measured in milliseconds on the MRI during the follow-up period	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	The Magnetic resonance imaging (MRI) will allow the observation.
The modifications observed after the injection in the adjacent tissues of the injected nucleus	Over 48 weeks for the first cohort (1L) / 36 weeks for the second cohort (2L) / 24 weeks for the third cohort (1-2L)	The Magnetic resonance imaging (MRI) will allow the observation of the corresponding adjacent tissues: * Annulus fibrosus; * Endplates; * Facets

Trial Locations

Locations (1)

Polyclinique Bordeaux Nord Aquitaine Centre Vertebra; 🇫🇷 Bordeaux, France