INFUSE®Bone Graft in Transforaminal Lumbar Interbody Fusion for Degenerative Disease of Lumbosacral Spine

The study is a prospective, multi-national study that compares INFUSE® Bone Graft
(investigational group) to autogenous bone graft (control group). Control group subjects
will receive the same surgical treatment except for the use of autogenous bone graft (from
the iliac crest) instead of INFUSE® Bone Graft. All sites will follow a common Clinical
Investigational Plan (CIP) that consists of the protocol and accompanying case report forms,
risk analysis, investigator's agreement, subject informed consent, institutional review
board (IRB) certification, labeling, and monitoring information.

Inclusion Criteria:

- Has advanced degenerative disease of the lumbosacral spine (L2 to S1) that results in
radiculopathy secondary to nerve root compression, manifested by, History of
radiating leg or buttock pain, paresthesias, numbness or weakness, or History of
neurogenic claudication.

- Has a history of low back pain

- Has radiographic evidence of advanced degenerative lumbosacral disease, such as
decreased disc height; herniated nucleus pulposus; hypertrophy or thickening of the
ligamentum flavum, annulus fibrosis, or facet joint capsule; hypertrophied facet
joints, facet joint space narrowing, or facet periarticular osteophyte formation;
trefoil canal shape; or lateral(subarticular) stenosis; or vertebral endplate
osteophyte formation; and at least one of the following:

Sagittal plane translation (slippage) of the superior (cranial) vertebral body anterior or
posterior to the inferior (caudal) vertebral body greater than 3mm, or Coronal plane
translation (slippage) of the superior (cranial) vertebral body lateral to the inferior
(caudal) vertebral body greater than 3mm, or Narrowing (stenosis) of the lumbar spinal
canal and/or intervertebral foramen

- Has single-level or adjacent two-level involvement from L2 to S1.

- Has preoperative Oswestry score ≥30.

- Has preoperative back pain score of ≥ 6 based on the Preoperative Back and Leg Pain
Questionnaire (pain intensity + pain frequency).

- Has preoperative leg pain score of ≥ 6 based on the Preoperative Back and Leg Pain
Questionnaire (pain intensity + pain frequency).

- Is at least 18 years of age and skeletally mature at the time of surgery.

- Has not responded to non-operative treatment (e.g., bed rest, physical therapy,
medications, spinal injections, manipulation, and/or TENS) for a period of six
months.

- Is willing and able to comply with the study plan and able to understand and sign the
Subject Informed Consent Form.

Exclusion Criteria:

- Requires spinal fusion at more than two lumbar levels or at two non-adjacent levels.

- Has had a prior lumbar surgical fusion procedure at the involved or adjacent spinal
levels.

- Has significant lumbar instability, defined as sagittal or coronal plane listhesis
greater than Grade 2 spondylolisthesis utilizing Meyerding's Classification
(Meyerding, HW, 1932).

- Has scoliosis greater than 30 degrees.

- Has had a previous diagnosis of osteoporosis, osteopenia, or osteomalacia.

- In addition, if the subject has any of the following risk factors, a DEXA scan should
be performed to determine eligibility:

History of a non-traumatic hip or spine fracture. Female who is postmenopausal. Female
over the age of 65. Male over the age of 70. If the DEXA T-score is -2.5 or lower, OR a
T-score of -1.5 or lower WITH a history of a vertebral compression fracture, the subject
is excluded.

- Is morbidly obese, as defined as a Body Mass Index (BMI) > 40.

- Has an active malignancy or prior history of malignancy (except for basal cell
carcinoma of the skin).

- Has an overt or active bacterial infection, either local or systemic.

- Has undergone systemic administration of any type of corticosteroid, anti-neoplastic,
immunostimulating, or immunosuppressive agents within 30 days prior to implantation
of the assigned treatment.

- Has a history of clinically significant cardiac or hematologic disease.

- Has a history of autoimmune disease known to affect bone metabolism or the spine.
Examples include spondyloarthropathies (e.g., ankylosing spondylitis, Crohn's
disease, and ulcerative colitis), juvenile arthritis, rheumatoid arthritis, Grave's
disease, and Hashimoto's thyroiditis.

- Has a medical disease or condition that would preclude accurate clinical evaluation
of the safety and effectiveness of the treatments in this study, such as motor
weakness, sensory loss, or painful conditions that inhibit normal ambulation or other
activities of daily living.

- Has a history of any endocrine or metabolic disorder known to affect osteogenesis
(e.g., Paget's disease, renal osteodystrophy, Ehlers-Danlos syndrome, or osteogenesis
imperfecta).

- Has chronic or acute renal and/or hepatic failure or prior history of renal and/or
hepatic parenchymal disease.

- Has a history of exposure to injectable collagen.

- Has received any previous exposure to any/all BMPs of either human or animal
extraction.

- Has a history of hypersensitivity to collagen or protein pharmaceuticals (e.g.,
monoclonal antibodies or gamma globulins).

- Has a history of any allergy resulting in anaphylaxis.

- Has a history of allergy to bovine products.

- Has a documented allergy or intolerance to titanium, titanium alloy, tantalum,
tantalum alloy, or polyetheretherketone (PEEK).

- Has any condition in which MRI scans are contraindicated (e.g., cardiac pacemaker,
brain aneurysm clips).

- Has any condition in which a gadolinium-contrast MRI is contraindicated (e.g., sickle
cell anemia, renal failure).

- Is mentally incompetent. If questionable, obtain psychiatric consult.

- Has a 'Waddell Signs of Inorganic Behavior' score of 3 or greater.

- Is a prisoner.

- Is a tobacco user who does not agree to suspend tobacco use prior to surgery.

- Is an alcohol and/or drug abuser as defined by currently undergoing treatment for
alcohol and/or drug abuse.

- Has received treatment with an investigational therapy (drug, device and/or biologic)
within 28 days prior to implantation surgery or such treatment is planned during the
24-month period following the study surgery.

- Is pregnant or nursing. Female of child-bearing potential must agree not to become
pregnant for one year following surgery.

- Is a Worker's Compensation case or is involved in spinal litigation.