The purpose of this trial is to demonstrate the safety and effectiveness of the CarboClear Pedicle Screw System, for skeletally mature DDD patients undergoing one level spinal fusion in combination with interbody fusion device, and requiring immediate, rigid, posterior spinal stabilization of the lumbar and/or sacral spine.

A prospective, multi-center, confirmatory, single arm, study. Results of the study will be compared to data from the literature.

The CarboClear Pedicle Screw System is designed for use with intervertebral body fusion device and with autogenous and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft, using PLIF or TLIF.

A total of 55 subjects will participate in the study, with up to 25 patients recruited at sites in Israel and at least 30 patients will be enrolled in US sites.

Follow-ups: Radiographic (AP, lateral and flexion/extension X-Rays) and clinical evaluations.

Follow-up sessions at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively, and then annually, until the last patient has completed 2-year follow-up.

Inclusion Criteria:

1. Subject has degenerative disc disease (DDD) at one level, from L2 to S1 vertebrae, with up to Grade I spondylolisthesis.

   DDD is defined as back pain and/or radicular leg pain with degeneration of the disc confirmed by patient history, radiographic studies, and physical examination, with one or more of the following factors (as measured radiographically, either by CT, MRI or plain film, myelography, discography, etc.):

   • osteophyte formation of facet joints or vertebral endplates;
   • decreased disc height, on average by > 2 mm;
   • scarring/thickening of ligamentum flavum, annulus fibrosis, or facet joint capsule;
   • herniated nucleus pulposus;
   • facet joint degeneration/changes;
   • vacuum phenomenon.

2. Subject is candidate for single level intervertebral fusion, with or without posterolateral fusion, with implantation of intervertebral body fusion device and supplemental fixation.

3. Subject age is between 21 - 72 years, and subject is skeletally mature.

4. Pre-operative low back and/or leg/s pain (debilitating pain that causes a significant disturbance of the routine daily physical activities) ≥ 40 mm on a 100 mm Visual Analogue Scale (VAS).

5. Pre-operative Oswestry Disability Index (ODI) score ≥ 40 percentage-point, indicating at least moderate disability (interpreted as moderate/severe disability).

6. Low back and/or leg/s pain is unresponsive to prior non-surgical management for a minimum of six months. Non-operative treatment includes pain medication, physical therapy and/or injections.

7. Patient must understand and sign the informed consent.

8. Patient is willing and able to meet the proposed follow-up schedule including return to follow-up visits and complete necessary study paperwork.

9. Patient is willing and able to follow the postoperative management program.

Exclusion Criteria:

1. Previous fusion or fusion attempts, including anterior fusion or posterolateral fusion, at the index level.
2. Previous fusion or fusion attempts at the adjacent levels.
3. Prior decompression procedures that include removal of soft and bone tissue at the index or adjacent levels.
4. Patient is not skeletally mature.
5. Degenerative spondylolisthesis greater than Grade I.
6. Spinal instability at the index level with ≥ 3 mm translation and/or ≥ 5 degrees angulation. Determination of instability will be assessed using flexion/extension lateral view radiographs.
7. Isthmic spondylolisthesis.
8. Radiographically confirmed moderate or severe spinal stenosis with associated neurogenic claudication. Radiographically confirmed moderate/severe stenosis is defined as reduction of ˃50% of central and/or foraminal canal diameter compared to the adjacent uninvolved levels. Neurogenic claudication is leg, groin or buttock pain and/or numbness that worsens with walking or erect posture and is relieved with flexion of the spine.
9. Systemic infection or infection at the site of surgery.
10. Metabolic bone disease, such as osteopenia, osteoporosis, and osteomalacia. A screening Questionnaire for osteoporosis, SCORE (Simple Calculated Osteoporosis Risk Estimation), will be used to screen patients who require a DEXA bone mineral density measurement. If DEXA is required, exclusion will be defined as measured T-score less than or equal to -2.5 (WHO definition).
11. History of Paget's disease or other bone pathologies, whether acquired or congenital, including renal osteodystrophy, untreated or uncontrolled hyperthyrodism, hypothyroidism, hyperparathyroidism, Ehrlers-Danlos-syndrome, osteogenesis imperfecta, achondroplasia, tuberculosis.
12. Personal and/or familial history NF2, and/or spinal tumor.
13. Ankylosing spondylitis.
14. Diffuse idiopathic skeletal hyperostosis (DISH) syndrome.
15. Active hepatitis (viral or serum) or HIV positive, renal failure, systemic lupus erythematosus, or any other significant medical conditions which would substantially increase the risk of surgery.
16. Immune deficiency disease.
17. Patient is receiving immunosuppressive or long-term steroid therapy.
18. Active malignancy or other significant medical comorbidities.
19. All concomitant diseases that can jeopardize the functioning and success of the patient.
20. Allergy to any component of the investigational device, including carbon fiber-reinforced polyetheretherketone (CFR-PEEK), titanium, and tantalum.
21. Pregnancy, or female subject interested in become pregnant during the duration of the study.
22. Current chemical dependency (e.g., drug and/or alcohol abuse, according to DSM-V definition), as well as those with a history of such abuse.
23. Uncontrolled depression, psychosis, or other symptoms of a mental disorder that, in the investigator's opinion, likely would make the subject unable to comply with the study procedures and could affect the study outcome.
24. Treatment with drugs that may interfere with bone metabolism, such as glucocorticosteroids, calcitonin, bisphosphonates, bone therapeutic doses of fluoride, bone therapeutic doses of vitamin D or vitamin D metabolites, and treatment by chemotherapy.
25. Morbid obesity (BMI ≥ 40).
26. Current smokers (including 3 months prior to surgery).
27. Scoliosis, Cobb angle greater than 11°.
28. Vertebral fractures.
29. Severe muscular, neural or vascular diseases that endanger the spinal column.
30. Missing bone structures, due to severely deformed anatomy or congenital anomalies, which make good anchorage of the implant impossible.
31. Paralysis.
32. Current use of other investigational drug or device.
33. The patient is involved in a worker's compensation case or spine-related litigation.
34. The patient is a prisoner.

Evaluation of complications/adverse events was conducted at each follow-up session, as well as throughout the study (within 24 months).

All adverse events (AEs), including non-serious AEs, non-device related, and anticipated AEs, were assessed by an independent Clinical Events Committee (CEC). AEs and serious adverse events (SAEs) were defined in accordance with the definition of ISO 14155.

This IDE study encountered a challenging follow-up schedule due to the COVID-19 pandemic. In particular, for several subjects, the 24-month visit occurred during the pandemic period, and was the cause for not attending this visit. On top of quarantine and limitations posed by authorities, a few subjects refused to arrive to hospital during that period.