3Spine granted investigational device exemption approval

MOTUS implant (3Spine)

3Spine has announced US Food and Drug Administration (FDA) investigational device exemption (IDE) approval for a US pivotal clinical trial for their MOTUS spinal implant.

The MOTUS device, the implant used in the BalancedBack total joint replacement procedure, is a ‘first of kind’ technology replacing the function of the disc and facet joints through a posterior approach, say 3Spine.

The company previously completed contracting and site initiation at 16 US centres for a prospective real-world evidence (RWE) fusion study, which has been enrolling since May 2021. As sites complete enrolment of their RWE cohort, each centre becomes eligible to participate in the IDE. 3Spine plans to complete enrolment of +/- 150 RWE patients to propensity match with +/- 150 IDE patients in an adaptive statistical design.

Medical device and biologics clinical research organisation (CRO), MCRA, supported 3Spine through the study design and IDE approval process. Justin Eggleton, vice president of spine regulatory affairs at MCRA, said: “This is important, breakthrough technology for an underserved patient population. The considerations for such a novel treatment required significant resources at FDA, and we appreciate the agency’s dedication to the review.

“The FDA review team carefully and thoughtfully challenged over 10,000 pages of biomechanical data, clinical history, and an exhaustive battery of non-clinical testing. FDA’s review establishes an important foundation for our project. MCRA is excited to partner with 3Spine as CRO for the IDE to strengthen the safety and effectiveness profile for our future pre-market approval application.”

Ron Yarbrough, chief operating officer at 3Spine, added: “Breakthrough device designation was critical to our success in the IDE approval process. This project is the culmination of decades of technical and clinical research in the lumbar spine, and while the courage of pioneering patients and surgeons brought us to this point, today it is all about the tenacity and expertise of the FDA review team.

“Our interactive review with FDA over the past two years has resulted in comprehensive coverage of an unparalleled number of technical disciplines, reflecting the potentially transformational nature of this spine technology. We are very excited to begin IDE enrolment.”

The BalancedBack total joint replacement procedure aims to address leg pain, back pain, and spinal instability, while correcting posture and restoring freedom of movement through reconstruction of the functional spinal unit. MOTUS was designated a Breakthrough device by the FDA in 2020.

The procedure is indicated for the biomechanical reconstruction and stabilisation of a spinal motion segment following decompression at one lumbar level from L1/L2 to L5/S1 for skeletally mature patients due to symptomatic lumbar degeneration with or without foraminal or recess spinal stenosis confirmed by radiographic imaging, with no more than a Grade 1 spondylolisthesis at the involved level.

Lumbar degeneration as defined as leg pain or neurologic symptoms with or without back pain due to reoccurring herniated nucleus pulposus, ligamentum flavum hypertrophy, facet degeneration, osteophyte formation, disc degeneration and/or annular degeneration, often causing spinal stenosis (radiculopathy, nerve root compression absent neurologic deficit, radiculitis, or neurogenic claudication).

Prior to receiving the BalancedBack total joint replacement, patients must have exhausted conservative treatment for at least three months or be determined to have a neurologic emergency or intractable pain.


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