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TerminatedNCT03507881ENNOVISTUpdated Sep 18, 2019

Prospective Study on Ennovate® Pedicle Screw Fixation in Isthmic Spondylolisthesis Patients

An observational study in Spine Fusion and Isthmic Spondylolisthesis, sponsored by Aesculap AG. Terminated at 3 sites in Germany. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2019-09-18.

Sponsored by Aesculap AG · Observational

Why this study was terminated
Recruitment too slow
Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
2
Ages
18 Years to 65 Years
Sex
All
01

Study summary

The present study is planned to demonstrate the efficacy and safety of a new pedicle screw system for the specific indication of isthmic spondylolisthesis, as this condition concerns relatively young patients requiring good fixation of the performed reposition to come to satisfactory clinical results.

Read the detailed description

Adult Isthmic spondylolisthesis, which is associated with "spondylolysis," is defined as an osseous discontinuity of the vertebral arch at the isthmus (the pars interarticularis), which usually occurs in the fifth lumbar vertebra. The prevalence of isthmic spondylosis is proposed to be about 6% to 26% in different studies. The European Spine Tango registry found 15%. It is proposed to affect more men than women. Conservative treatments including braces, physical therapy, and medication are shown to be effective for some patients; however, surgical treatments are mainly the final effective treatment. There are several different options for surgery among which posterolateral fusion (PLF) is considered as the method of choice. It is shown that PLF is more effective than conservative treatments such as exercise. The fusion helps to fix the motion of the affected segment and therefore, might lead to pain reduction. Decompression, supplemental instrumentation, and supplemental anterior column support are also considered for treatment. These treatment strategies can be used separately or in any combination; however, studies trying to compare separate treatments with a combination of them have led to inconsistent results.

Supplementary pedicle screws might be added to fusion methods for fixation and it is proposed that they have the ability to correct the deformity, reduce the listhesis, and increase the fusion rates, although a majority of the studies comparing instrumented PLF and noninstrumented PLF could not show the superiority of instrumented approaches. The literature has been reviewed in 2000 already, and the method has already been proved to be "practical, safe, and effective" for various spinal indications. Other authors found a better result for isthmic spondylolisthesis patients with posterior lumbar interbody Fusion (PLIF), vs. PLF, especially for high grade isthmic spondylolisthesis.

The present study is planned to demonstrate the efficacy and safety of a new pedicle screw system for the specific indication of isthmic spondylolisthesis, as this condition concerns relatively young patients requiring good fixation also in the long-term.

02

Conditions studied

  • Spine Fusion
  • Isthmic Spondylolisthesis

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Keywords

  • isthmic spondylolisthesis
03

In context

Spondylolisthesis

237 studies on the registry are indexed under Spondylolisthesis; 47 are open to participants now.

This study's enrollment of 2 is below the median of 121 across 80 observational studies indexed under Spondylolisthesis.

Browse Spondylolisthesis studies →

Lead sponsor

Aesculap AG is the lead sponsor of 104 studies on the registry; 20 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

adult patients

Inclusion criteria

  • Symptomatic single-level IS (L4-S1), (VAS > 30mm, treated conservatively for a minimum of 6 months)
  • Isthmic Spondylolisthesis Meyerding grade I and II
  • Signed Informed Consent of the patient regarding the participation in this study

Exclusion criteria

Exclusion Criteria:

  • Multilevel IS
  • Severe degenerative changes of cranial adjacent level (disc height of \<50% of the next healthy segment,
  • Previous lumbar spine surgery except microdiscectomy or micro- decompression of the index level
  • Patients psychically or mentally not able to give or refuse consent
  • Patients psychically or mentally not able to answer the questions regarding their health status and quality of life
  • Pregnancy (current or planned)
  • BMI >35
  • Systemic or local infection
  • Chemotherapy or radiation ongoing
  • Desire of early retirement (running pension request)
  • All contraindications as listed in the instructions for use
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Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
2 participants (actual)

Groups and cohorts

  • Ennovate

    Implantation of an Ennovate® internal fixation

    Device: fusion

Interventions

  • Devicefusion

    Internal fixation

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What researchers measure

Primary outcomes

  1. Leg pain

    Leg Pain measured by Visual analogue scale (VAS) after 1 year follow-up: measured by Visual Analogue Scale: The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points.

    Time frame: 1 year

Secondary outcomes

  1. Leg Pain

    Leg Pain measured by Visual analogue scale (VAS) at all timepoints except 1 year; measured by Visual Analogue Scale: The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points.

    Time frame: Preoperative, 3 months, 6 months

  2. Back Pain

    Back Pain measured by Visual analogue scale (VAS) at all timepoints; measured by Visual Analogue Scale: The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points.

    Time frame: Preoperative, 3 months, 6 months, 1 year

  3. Functional Disability

    Measured by Oswestry Disability Index (ODI) at all timepoints; The ODI is an index derived from the Oswestry Low Back Pain Questionnaire to quantify disability for low back pain. The self-completed questionnaire contains ten Topics: intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel. Each topic category is followed by 6 statements describing different potential scenarios in the patient's life relating to the topic. Each question is scored on a scale of 0-5 with the first statement being zero and indicating the least amount of disability and the last statement is scored 5 indicating most severe disability. The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible.

    Time frame: Preoperative, 3 months, 6 months, 1 year

  4. Patient satisfaction

    Patient Satisfaction with Operation Result (very high / high / medium / low / very low)

    Time frame: 3 months, 6 months, 1 year

  5. Quality of Life

    Quality of Life measured by EQ-5D-5L Questionnaire: The 5-level EQ-5D version (EQ-5D-5L) was introduced by the EuroQol Group in 2009 to improve the instrument's sensitivity and to reduce ceiling effects, as compared to the EQ-5D-3L. The EQ-5D-5L essentially consists of 2 pages: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety / depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.

    Time frame: preoperative, 3 months, 6 months, 1 year

  6. Clinical Complications

    Adverse Events (AE) and Serious Adverse Events (SAE) forms filled at all timepoints intraop and postop

    Time frame: intraoperative, 3 months, 6 months, 1 year

  7. Fusion status

    Fusion assessment (acc. to Bridwell)

    Time frame: 3 months, 6 months, 1 year

  8. Radiographically assessed complications

    Construct stability, loosening, implant breakage, other adverse events (Osteolysis, screw misplacement, device migration)

    Time frame: 3 months, 6 months, 1 year

  9. Loss of Reduction of the Reposition [degree]

    Results regarding the maintenance of the reposition of the isthmic spondylolisthesis throughout the follow-up; loss of reduction during follow-up measured in \[degree\]

    Time frame: 3 months, 6 months, 1 year

  10. Range of Motion

    Range of motion (angular and translational; degrees/mm)

    Time frame: 3 months, 6 months, 1 year

07

Study locations

3 sites
  • Klinikum der J. W. Goethe-Universität, Klinik für Allgemein- und Visceralchirurgie
    Frankfurt am Main, 60590, Germany
  • Katholisches Klinikum Koblenz
    Koblenz, 56073, Germany
  • Sana Klinikum Offenbach GmbH
    Offenbach, 63069, Germany
08

References and documents

Publications

  • Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am. 2000 Oct;82(10):1458-76. doi: 10.2106/00004623-200010000-00013. PubMed 11057475 ↗
  • Dehoux E, Fourati E, Madi K, Reddy B, Segal P. Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years. Acta Orthop Belg. 2004 Dec;70(6):578-82. PubMed 15669459 ↗
  • Etemadifar MR, Hadi A, Masouleh MF. Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up. J Craniovertebr Junction Spine. 2016 Jan-Mar;7(1):43-9. doi: 10.4103/0974-8237.176623. PubMed 27041885 ↗
  • Taillard WF. Etiology of spondylolisthesis. Clin Orthop Relat Res. 1976 Jun;(117):30-9. PubMed 1277680 ↗
  • Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009 Jan 15;34(2):199-205. doi: 10.1097/BRS.0b013e31818edcfd. PubMed 19139672 ↗
  • McTimoney CA, Micheli LJ. Current evaluation and management of spondylolysis and spondylolisthesis. Curr Sports Med Rep. 2003 Feb;2(1):41-6. doi: 10.1249/00149619-200302000-00008. PubMed 12831675 ↗
  • STEWART TD. [The age incidence of neural-arch defects in Alaskan natives, considered from the standpoint of etiology]. J Bone Joint Surg Am. 1953 Oct;35-A(4):937-50. No abstract available. Undetermined Language. PubMed 13108895 ↗
  • Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment. Clin Orthop Relat Res. 1993 Dec;(297):65-70. PubMed 8242953 ↗
  • Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006 Apr;15(4):391-402. doi: 10.1007/s00586-005-1021-4. Epub 2005 Oct 11. PubMed 16217665 ↗
  • GILL GG, MANNING JG, WHITE HL. Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg Am. 1955 Jun;37-A(3):493-520. No abstract available. PubMed 14381447 ↗
  • France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, Coe JD, Topper SM. A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine (Phila Pa 1976). 1999 Mar 15;24(6):553-60. doi: 10.1097/00007632-199903150-00010. PubMed 10101819 ↗
  • Moller H, Hedlund R. Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis--a prospective randomized study: part 2. Spine (Phila Pa 1976). 2000 Jul 1;25(13):1716-21. doi: 10.1097/00007632-200007010-00017. PubMed 10870149 ↗
  • Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine (Phila Pa 1976). 1997 Dec 15;22(24):2813-22. doi: 10.1097/00007632-199712150-00004. PubMed 9431617 ↗
  • McGuire RA, Amundson GM. The use of primary internal fixation in spondylolisthesis. Spine (Phila Pa 1976). 1993 Sep 15;18(12):1662-72. doi: 10.1097/00007632-199309000-00015. PubMed 8235847 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 18, 2019, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT03507881
Lead sponsor
Aesculap AG
Collaborators
Raylytic GmbH, ZKS Münster
Responsible party
Sponsor
First posted
Apr 25, 2018
Start date
Jul 31, 2018
Primary completion
Jan 18, 2019
Completion
Jan 18, 2019
Last update
Sep 18, 2019

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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