Assessment of nanOss Bioactive 3D in the Posterolateral Spine

The post market clinical investigation is designed to assess instrumented PLF using nanOss
Bioactive 3D bone void filler with autograft bone and bone marrow aspirate in patients with
symptomatic spinal stenosis secondary to degenerative disc disease (DDD) with up to Grade 1
spondylolisthesis at one or two adjacent levels from L2-S1 characterized by the inclusion and
exclusion criteria.

Patients will be evaluated at Preop, discharge, 6 and 12 months. X-rays will be obtained at
each visit; Additionally, a CT scan will be performed at the 12 month postoperative visit to
assess fusion status.

Inclusion Criteria:

- At least 21 years of age and skeletally mature.

- Symptomatic spinal stenosis secondary to DDD with up to Grade 1 spondylolisthesis at
one or two adjacent levels from L2-S1 requiring instrumented PLF surgery.

- Completed a minimum of 6 months of non-operative treatment.

- Pre-operative objective evidence of primary diagnosis confirmed by appropriate imaging
studies (AP, Lateral, Flexion and Extension images and an MRI or CT scan).

- Is willing and able to return for post-treatment exams according to the follow-up
called for in the protocol.

- Is able to review, understand and sign the informed consent document.

Exclusion Criteria:

- Symptomatic at more than two levels.

- Has had previous fusion surgery at the level(s) to be treated (previous discectomy,
laminotomy, laminectomy or nucleolysis at the level(s) to be treated < 6 months ago is
ok).

- Has > 11 degrees lumbar scoliosis.

- Has > 40 BMI.

- Has > Grade 1 spondylolisthesis.

- Has osteoporosis (T-score of -2.5 or below), osteomalacia, Paget's disease or
metabolic bone disease.

- Has a disease that significantly inhibits bone healing (e.g., diabetes type 1, renal
failure, impaired calcium metabolism).

- Has a medical condition that requires or has a history of chronic steroid use (i.e.,
oral steroids), with the exception of inhaled/nasal corticosteroids steroids or has
any medical condition that requires treatment with drugs known to interfere with bone
healing.

- Has a neurological disease (e.g., Parkinson's disease), a psychosocial disorder (e.g.,
suicidal, diminished capacity) or has a history of substance abuse which would
preclude accurate evaluation or limit the ability to comply with study requirements.

- Has either an active infection or infection at the site of surgery

- Has a systemic disease (e.g., AIDS, HIV, active hepatitis, tuberculosis)

- Has rheumatoid arthritis or other autoimmune disease.

- Has spinal tumors.

- Has an active malignancy (except non-melanoma skin cancer) or history of any invasive
malignancy unless treated and in remission for at least five years.

- Has a known sensitivity or allergies to porcine collagen, PEEK, tantalum or titanium.

- Has active arachnoiditis.

- Has fractures of the epiphyseal plate or fractures for which stabilization of the
fracture is not possible.

- Is a prisoner.

- Is involved in spinal litigation at the treated level(s).

- Is participating in another clinical study that would confound Study data.

- Is pregnant or is interested in becoming pregnant while participating in the Study.