A Study of Infuse® Bone Graft With Mastergraft® Strip and Posterior Fixation for Posterolateral Fusion (PLF) Treatment of Multi-Level Degenerative Lumbosacral Spinal Conditions

Inclusion Criteria:

1. Degenerative lumbar spine condition:

1. Requiring a PLF procedure using a bilateral metallic screw and rod system in 2-4
consecutive levels from L2-S1; and

2. Diagnosed with: instability (up to and including Grade 2 spondylolisthesis,
retrolisthesis, or lateral listhesis), stenosis with documented pre-operative
instability, and/or recurrent disc herniation, any of which may have possible
concomitant lumbar degenerative deformity (Cobb angle ≤ 30 degrees).

2. Preoperative ODI score ≥40.

3. Preoperative pain score of ≥8 (out of 20) on the Preoperative Leg Pain Questionnaire.

4. Most inferior treated spinal level is able to accommodate an interbody fusion device.

5. ≥21 years of age at the time of signing the informed consent.

6. Failed ≥6 months non-operative treatment (e.g., bed rest, physical therapy,
medications, spinal injections, manipulation, and/or TENS).

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

Exclusion Criteria:

1. Prior spinal fusion surgical procedure at the involved or adjacent spinal levels.
(Prior non-fusion surgery at the target levels, including discectomy and/or
single-level foraminotomy or laminectomy, is allowed.)

2. Prior lumbar disc arthroplasty.

3. Significant lumbar instability, defined as sagittal listhesis >Grade 2 at any involved
level using Meyerding's Classification or lateral listhesis >25% lateral translation
at any involved level.

4. Planned use of an internal or external bone growth stimulator.

5. Lumbar scoliosis >30 degrees.

6. Osteoporosis to a degree that spinal instrumentation is contraindicated or a history
of atraumatic vertebral fracture.

7. Morbidly obese, as defined by a Body Mass Index (BMI) >40.

8. Presence of active malignancy or prior history of malignancy.

9. Overt or active bacterial infection, either local or systemic.

10. 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.

11. Comorbidities precluding subject from being a surgical candidate.

12. History of autoimmune disease known to affect bone metabolism or the spine (e.g.,
spondyloarthropathies, juvenile arthritis, rheumatoid arthritis, Graves' disease,
Hashimoto's thyroiditis).

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

14. History of exposure to any recombinant proteins used for bone formation (i.e., Infuse
Bone Graft, OP-1 Putty, OP-1 Implant, AUGMENT Bone Graft, GEM21S, i-FACTOR Peptide
Enhanced Bone Graft, or PepGen P-15 Synthetic Bone Graft).

15. Hypersensitivity or allergy to any components of the study treatments including, but
not limited to, bone morphogenetic proteins (BMPs); injectable collagen; protein
pharmaceuticals (e.g., monoclonal antibodies or gamma globulins); bovine collagen
products; gentamicin or glycerol (which may be present in trace amounts in the DBM
products); and/or instrumentation materials (titanium, titanium alloy, cobalt chrome,
cobalt chrome alloy, or polyetheretherketone [PEEK]).

16. History of any allergy resulting in anaphylaxis.

17. Is a prisoner.

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

19. Treatment with an investigational therapy (drug, device, and/or biologic) within 30
days prior to implantation surgery, or such treatment is planned during the 24-month
period following implantation of the study treatment.

20. Pregnant or nursing. Females of child-bearing potential must agree not to become
pregnant for one year following surgery.

21. Any condition that would interfere with the subject's ability to comply with study
instructions, might confound the interpretation of the study, or put the subject at
risk.