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| General |
| Study Status |
Ongoing |
Application Number /
Requirement Number |
P220002 / PAS001 |
| Date Original Protocol Accepted |
08/11/2023
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| Date Current Protocol Accepted |
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| Study Name |
The TOPS System Continued F/U Study
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| Device Name |
TOPS™ System
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| Clinical Trial Number(s) |
NCT01933607 NCT02234154 NCT03012776
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| General Study Protocol Parameters |
| Study Design |
Randomized Clinical Trial
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| Data Source |
New Data Collection
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| Comparison Group |
Concurrent Control
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| Analysis Type |
Analytical
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| Study Population |
Adult: >21
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| Detailed Study Protocol Parameters |
| Study Objectives |
The purpose of this prospective, randomized, concurrently controlled, multi-center study is to evaluate the safety and effectiveness of the TOPS™ System versus to lumbar spinal fusion control.
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| Study Population |
Participants in the IDE study who failed at least 6 months of conservative therapy for treatment of leg pain with or without back pain at one vertebral level between L2 and L5 stemming from (1) moderate to severe central, foraminal, and/or subarticular recess lumbar spinal stenosis (LSS) and (2) up to Grade I degenerative spondylolisthesis or equivalent retrolisthesis and (3) thickening of the ligamentum flavum or scaring facet joint capsule.
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| Sample Size |
A total of 299 subjects in the Per Protocol analysis set (206 TOPS, 93 fusion control) who were enrolled into the Pivotal study and are continuing follow up to 5 years. Assuming 85% compliance, it implies 175 TOPS subjects and 79 Fusion controls. If compliance in controls is only 80%, this implies a control sample size of 74.
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| Key Study Endpoints |
Primary Effectiveness Endpoint:
The primary effectiveness endpoint is a composite clinical success (CCS) responder endpoint based on clinical status at Month 60. An individual subject will be regarded as achieving Month 60 CCS only if s/he meets all of the following criteria at 60-months compared to baseline:
A reduction of 15 points or more in the 60-month Oswestry Disability Index (ODI) compared to baseline;
No new or worsening, persistent neurologic deficit;
No epidural steroid injection, facet joint injections, nerve block procedures or implantable spinal cord stimulator to treat back or leg pain symptoms at any lumbar level;
Any TOPS subject will be considered a failure if fusion occurs as defined in the radiographic protocol. Any Fusion subject will be considered a failure if fusion (as defined in the radiographic protocol) does not occur. This assessment will be made by a core lab;
No revision or removal of implants;
No supplemental fixation at the index level or at the immediately adjacent levels;
No occurrence of a major device related adverse event.
Secondary Endpoints:
Individual components of 60-month composite clinical success (CCS);
CCS at Months 36 and 48;
ODI, changes from baseline in ODI, and 15 point improvement in ODI;
Visual analog scale (VAS) for back pain and worse leg pain, changes from baseline in VAS, and 20 mm improvement in VAS; for VAS, the higher of the two leg scores at baseline will be used for analysis purposes.
ZCQ findings;
o Improvement of greater than or equal to 0.5in ZCQ physical symptom score and symptom severity and less than or equal to 2.5 on ZCQ subject satisfaction over time.
o Overall ZCQ success defined as meeting all 2 of 3 individual ZCQ success criteria.
o Overall ZCQ success defined as meeting all three individual ZCQ success criteria.
Reduction in physical component score on SF-12;
Time to revision or removal, or supplemental fixation at index or adjacent level;
Narcotics use for lower back pain and leg pain;
Range of motion in flexion/extension at the index and immediately adjacent levels
Safety Endpoint:
Evaluation of the incidence and severity of complications and adverse reactions associated with the treatment.
The following AE listings will be constructed:
All AEs Sorted by Group and Event Type
All AEs Sorted by Group and Subject
Serious AEs
Severe AEs
Device Related AEs
Serious Device Related AEs
Severe Device Related AEs
Severe Life-Threatening AEs
Procedure Related AEs
Other AEs
AEs among subjects discontinued early
AEs among subjects who died.
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| Follow-up Visits and Length of Follow-up |
After 24-month follow-up visit, the subject will continue to be followed long term annual post 24 months, at 36, 48, until patient reaches 60 months.
60 months (5 years) post-implant
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| Interim or Final Data Summary |
| Interim Results |
Safety Results
In the mITT population (211 TOPS™, 98 Fusion):
Overall AEs: 83.4% TOPS™ vs 78.6% Fusion (difference: 4.8%, 95% CI: -4.7% to 14.4%)
Device-related AEs: 28.9% TOPS™ vs 34.7% Fusion (difference: -5.8%, 95% CI: -17.0% to 5.5%)
SAEs: 41.2% TOPS™ vs 34.7% Fusion, but device-related SAEs were lower in TOPS™ (6.2% vs 7.1%)
Reoperations: 8.6% TOPS™ vs 14.6% Fusion through 24 months
Note: Most common AE categories were musculoskeletal/connective tissue disorders and injury/procedural complications in both groups.
Effectiveness Results:
24-Month CCS Results (final data):
TOPS™ demonstrated superiority with 79.1% success (159/201) vs 27.5% Fusion success (25/91), difference of 51.6% (p<0.0000001).
Key secondary outcomes favor TOPS™:
ODI improvement greater than or equal to 15 points: 95.5% TOPS™ vs 84.7% Fusion
Motion preservation: TOPS™ maintained baseline range of motion while Fusion lost ~3° flexion-extension
Fusion status success: 98.4% TOPS™ (no fusion) vs 46.4% Fusion (achieved fusion)
36/48/60-month CCS data: Not yet available as insufficient subjects have reached these timepoints. While some individual patient data may be available for subjects who have reached these timepoints, the CCS analysis requires sufficient numbers of subjects to have completed each timepoint before the composite endpoint can be meaningfully analyzed and reported.
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| Actual Number of Patients Enrolled |
309 mITT subjects who underwent surgery (211 TOPS™, 98 Fusion)
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| Actual Number of Sites Enrolled |
37 (34 active and 3 closed due to subject completion)
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| Patient Follow-up Rate |
Month 6: 97.0% TOPS™, 93.3% Fusion
Month 12: 97.8% TOPS™, 92.1% Fusion
Month 24: 91.6% TOPS™, 77% Fusion
Month 36: 90% TOPS™, 77% Fusion
Month 48: 86.8% TOPS™, 76.0% Fusion
Month 60: Limited data (ongoing follow-up)
Loss to Follow-up (7 total subjects)
TOPS™ Group: 3 subjects
Subject 09-012: Lost to follow-up after 24-month visit
Subject 34-004: Lost to follow-up after 12-month visit
Subject 43-001: Lost to follow-up after 36-month visit (subject is incarcerated)
Fusion Group: 4 subjects
Subject 09-021: Lost to follow-up
Subject 19-038: Lost to follow-up after 6-month visit
Subject 24-003: Lost to follow-up after 6-month visit
Subject 34-005: Lost to follow-up after 24-month visit
The sponsor noted that among the 309 mITT patients taken to surgery as part of the IDE, 28 patients have terminated early, including 4 patients (2 TOPS, 2 Fusion) that were considered withdrawn from the study intraoperatively due to the operating surgeon’s decision to intraoperatively change to a non-study treatment (row “A3aii” in the above table), as well as 24 subjects who were withdrawn following the index surgery (row “A3bi” in the above table), 3 of which (2 TOPS, 1 Fusion) are newly reported since the 12 month PAS report. See Table 2: Subject Accounting at the Time of Database Lock for more information. Additionally, see the 24 month PAS progress report for more information on the specific subjects withdrawn intraoperatively, and of those that were withdrawn following both TOPS™ and Fusion treatment.
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