OsseoFix™ Spinal Fracture Reduction System in Treating Spinal Compression Fracture

This is a prospective, multi-center clinical study designed to evaluate safety and
effectiveness of the OsseoFix Spinal Fracture Reduction System used with PMMA bone cement
relative to the clinical expectations for treatment of vertebral compression fractures
(VCFs). The study will be conducted at up to 15 investigational centers in the United States
in 115 (up to 125) subjects with one or two vertebral compression fractures between levels T6
and L5 implanted with the investigational device(s).

Baseline screening will be completed to determine eligible subjects. VCFs will be confirmed
by magnetic resonance imaging (MRI), or by a CT / bone scan. These diagnostic tests will be
utilized to confirm that there are no retropulsed bone fragments. Subjects who meet all
inclusion criteria and do not have any exclusion criteria will be scheduled to receive the
OsseoFix Spinal Fracture Reduction System.

Subjects that are enrolled will be implanted with the OsseoFix Spinal Fracture Reduction
System through a postero-lateral approach to the anterior vertebral body using instruments
specifically designed for this procedure.

Radiographs will be taken at each follow-up visit, including baseline and post-operatively.
Subject's perception of pain will be assessed using the Visual Analogue Scale (VAS).
Functional outcomes will be measured using the Oswestry Disability Index (ODI) and Short
Form- 36 (SF-36) questionnaires as well as their neurologic status. The VAS, ODI, SF-36 and
neurologic status will be measured at baseline, 4-week, 3-month, 6-month and 12-month
follow-up visits. Overall patient-satisfaction will be evaluated at all post-implant
scheduled follow-up visits. Adverse event will be the recorded in all scheduled and
non-scheduled visits.

The endpoint analysis will be performed and submitted when all implanted subjects have
completed their 12-months follow-up.

Inclusion Criteria:

- 5o years of age.

- Legal US citizen with ability to read and write.

- Acute painful fracture (≤2 months) between T6 to L5 as evidenced by plain radiography,
CT / Bone scan, and/or magnetic resonance imaging.

- Subject is...

- Non-Standard Treatment:

- Inability to tolerate prolonged conservative care due to intractable pain
(VAS 70/100) with maximum tolerated medication for at least 2 weeks, but
less than 6 weeks; OR

- Inability to tolerate prolonged immobilization due to other comorbid
conditions aggravated by immobility for at least 2 weeks, but less than 6
weeks; OR

- Intolerance of or adverse reaction to available pain medications for at
least 2 weeks, but less than 6 weeks; OR

- Hospitalization secondary to pain for at least 2 weeks, but less than 6
weeks.

- Standard Treatment:

- Has undergone at least 6 weeks of conservative care.

- Have a self assessment VAS score ≥ 50 mm at the Baseline visit.

- Have 30% or greater disability score on ODI at the Baseline visit.

- Anterior wedge deformity with no less than 5% and no more than 75% loss of anterior
cortical height as compared to the posterior cortical height of the same vertebral
body.

- Bone mineral density (BMD) T-score of -1.5 or less, as determined by a DEXA scan.

- Intact posterior cortical vertebral body wall.

- Type A compression fractures according to AO classification of spinal vertebral
fractures.

- If a transpedicular approach is utilized the pedicle diameter must be equal to or
greater than 6.5 mm; however, if an extrapedicular approach is utilized there is not a
minimum pedicle width requirement.

- Subject is willing and able to provide informed consent and agrees to release medical
information for purposes of this study (HIPAA authorization) and to return for
scheduled follow-up evaluations.

Exclusion Criteria:

- Significant vertebral collapse defined as more than 75% of original vertebral height
or less than 5% or a burst or pedicle fracture with posterior cortical wall
disruption.

- Presence of healed fracture at the intended treatment level(s) based on a CT / bone
scan or MRI.

- Compression fractures requiring treatment at 3 or more levels.

- Spinal/Foraminal canal compromised.

- Significant deformity/instability indicated by:

- Segmental kyphosis > 30 degrees, or

- translation > 4 mm.

- VAS back pain score of < 50 mm.

- ODI score of < 30%.

- Have a documented active systemic or local infection, such as AIDS, hepatitis, with a
WBC greater than 11.5 and a temperature greater than 101.5°F.

- Spinal surgery in the thoracic and/or lumbar region within the past year

- Previous kyphoplasty or vertebroplasty at involved level or level above or below
treated level.

- Spinal arthrodesis within 2 adjacent levels of fracture.

- Non-ambulatory prior to fracture.

- Greater than Grade 1 spondylolisthesis at level of fracture.

- Scoliosis > 10 degrees.

- BMI > 40.

- Severe cardiopulmonary deficiencies.

- Pregnant.

- Type I or II diabetes without controlled A1C level.

- Achondrogenesis disorders.

- Active malignancy, hemangiomas at the operative level(s), or multiple myeloma.

- No generally accepted medical contraindication to spinal surgery and/or general
anesthesia, such as coagulopathy with a threshold for INR at 1.5 or less, and platelet
count 100,000.

- A life expectancy less than the study duration or undergoing palliative care.

- Trauma injuries aside from vertebral compression fracture(s).

- Injuries that violate the posterior vertebral cortex and/or posterior column.

- Active litigation.

- Currently on workman's compensation.

- Autoimmune disorders.

- Non-spine pain that requires daily Opioids.

- Systemic long-term steroid use - greater than 6 months.

- Active multiple sclerosis or neurologic deficit caudal to fracture.

- Currently an alcohol, solvent, or drug abuser.

- Psychiatric or cognitive impairment that, in the opinion of the investigator, would
interfere with the subject's ability to comply with the study requirements.

- History of allergies to any of the device components including but not limited to
commercially pure titanium, titanium alloy, polymethylmethacrylate or Zirconium Oxide
(ZrO2)

- Incarcerated.

- Are currently participating in another investigational study.

- Having had another device implanted in the thoracic and/or lumbar area that would
interfere with the surgical approach, study device, or follow-up evaluations.