A Prospective Study of Instrumented, Posterolateral Lumbar Fusions (PLF) With OsteoAMP®

The objective of this clinical study are: to evaluate the long term efficacy of OsteoAMP in
patients requiring 1 to 2 adjacent level, instrumented posterolateral spinal fusion
procedure of the lumbar or lumbosacral spine, and to evaluate OsteoAMP in spinal fusion
procedures based on fusion results, adverse event rates, and pain and health scores.

Patients that are scheduled to undergo instrumented, posterolateral spinal fusion (PLF)
surgery as part of their medical treatment and comply with the study eligibility criteria
will be recruited and entered into the study. Subjects recruited into the study will receive
OsteoAMP as part of an instrumented PLF surgical procedure. The surgery may also include
nerve root decompressions through laminectomies and foraminotomies. As is consistent with
the current standard of care.

The study involves consecutive patients suffering from lower back and leg pain due to
degenerative disc disease (DDD), degenerative spondylolisthesis (up to grade 1), and/or mild
degenerative scoliosis that are candidates for an instrumented PLF with pedicle screws in 1
or 2 motion segments of the lumbar or lumbosacral spine. Patients will require a total bone
graft volume of at least 10cc per side per level in the PLF procedure, including OsteoAMP
granules hydrated with bone marrow aspirate (BMA) and local autogenous bone.

Subjects will be followed for 24 months post-surgery.

Summary of Inclusion Criteria:

1. Aged 21 to 85 years and skeletally mature at time of surgery

2. Diagnosis of degenerative disc disease (DDD), degenerative spondylolisthesis (up to
grade 1), and/or mild degenerative scoliosis (up to 25°) curvature

3. One or more of the following are met: -instability (defined a angulation greater than
or equal to 5 degrees and/or translation greater than or equal 4mm based on
flexion/extension radiographs, -osteophyte formation, - decreased disc height, -
thickening of ligamentous tissue, disc degeneration or herniation,- facet joint
degeneration

4. Requires fusion (i.e., Symptomatic) at up to two contiguous levels from L1 to S1.

5. Preoperative ODI score of more than 30

6. Non-responsive to non-operative treatment for at least 6 months.

7. Lower back pain with or without claudication.

8. If of child-bearing potential, non-pregnant, non-nursing, and agrees to use
contraception for up to 2 years following surgery

9. Willing and able to comply with study plan and able to understand and sign informed
consent

Summary of Exclusion Criteria

1. Primary diagnosis of a spinal disorder other than DDD, degenerative spondylolisthesis
up to Grade 1 or mild degenerative scoliosis of up to 25 degrees curvature

2. Requires fusion of more than 2 vertebral levels or of 2 non-adjacent vertebral levels

3. Conditions requiring medications that interfere with fusion or bone metabolism

4. More than one immobile vertebral level between L1 and S1 from any cause

5. Overt or active local or systemic infection, including latent infection around the
surgical implantation site

6. Clinically severe obesity as defined by the National Institutes of Health

7. Uncontrolled diabetes mellitus as confirmed by HbA1c greater than 8%

8. History of osteoporosis or other metabolic bone disorders, including Paget's disease
and osteomalacia

9. History of hypersensitivity to any of the agents used to process OsteoAMP

10. History of autoimmune disease

11. Received other bone graft substitutes

12. Received medication that may interfere with fusion or bone metabolism within 2 weeks
of planned surgery

13. Received or plans to receive investigational therapy

14. Presence of active malignancy unless he/she has been treated with curative intent and
there have been no clinical signs or symptoms of malignancy for at least 3 years

15. Presence of systemic disease or condition, which affects his/her ability to
participate in the study requirements or the ability to evaluate the efficacy of the
product

16. Prisoner, transient, or has been treated for chemical/alcohol dependency in an
inpatient substance abuse program within 6 months prior to study enrollment or has
significant psychosocial disturbance that would affect participation in the study, in
the opinion of the investigator

17. Any condition for which the surgical procedure, in the opinion of the Investigator,
poses an undue risk

18. Pursuing litigation related to cervical and/or lumbar/lumbosacral spine