Interbody Spacers With map3® Cellular Allogeneic Bone Graft in Anterior or Lateral Lumbar Interbody Fusion

Map3 is an allogeneic bone matrix which also contains demineralized cortical cancellous bone
and multipotent adult progenitor cells (MAPC). MAPC-based cells are derived from allograft
bone marrow, isolated from other cells and cryopreserved. Both the scaffold and cellular
constituents are processed from the same donor but are provided in separate containers.
Scaffold and cells combined constitute the implant and must be used together. The map3
implant is available in Strips allograft and Chips allograft configurations.

Inclusion Criteria:

- is at least 18 - 75 years of age and skeletally mature

- must have symptomatic spondylosis, spondylolisthesis grade I or II, or degenerative
disc disease (DDD) at one level from L2-S1 requiring a fusion

- must be a candidate to use an allograft spacer

- must be a candidate for bilateral pedicle screw placement

- must have completed a minimum of six weeks (+/- two to four weeks of bracing) of
unsuccessful conservative, non-operative care

- must have discogenic back pain with or without leg pain DDD must be confirmed by MRI
or CT scans followed by discography (if necessary)

- must score at least 40 % on the Oswestry Disability Index

- must score 4 or more on a 10 cm Visual Analog Scale for back pain or leg pain

- must be able to comply with the protocol's follow-up schedule

- must understand and sign the informed consent documenT

Exclusion Criteria:

- symptomatic at more than one level

- previous fusion surgery at any lumbar level with or without instrumentation.

- any other bone grafting product other than study product and local autograft bone.
e.g. rhBMP2, (recombinant human bone morphogenetic protein 2).

- patients requiring any other interbody fusion device other than an allograft spacer
(Bigfoot™, Crossfuse® Advantage). e.g. no PEEK IBF

- more than 50% spondylolisthesis (Myerding grade III or more)

- lumbar scoliosis greater than 11 degrees

- osteoporosis* (T-score of −2.5 or lower), osteomalacia, Paget's disease or --metabolic
bone disease.

- spinal tumors

- active arachnoiditis

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

- impaired calcium metabolism

- active infection or surgical site infection

- rheumatoid arthritis or other autoimmune disease that affects bone healing (at the
surgeon's discretion)

- chronic steroid use except for chronic inhalers (used steroids for one month within
the last 6 months) or any medical condition that requires treatment with drugs known
to interfere with bone healing

- use of glucocorticoids > 10 mg/day

- systemic disease such as AIDS, HIV, hepatitis (active), tuberculosis

- morbid obesity defined as body mass index (BMI) >45 or a weight more than 100 lbs.
over ideal body weight

- uncontrolled diabetes documented with an Hbg A1C >9 or insulin dependent diabetics

- smokers unless approved by Sponsor, including electronic cigarettes and vaporizers

- within the past two (2) years, psychosocial disorders that would preclude accurate
evaluation or has a history of substance abuse any history or active cancer

- pregnancy, or interested in becoming pregnant while participating in the study

- participation in another investigational study within 30 days