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When used as a pedicle screw fixation system of the non-cervical posterior spine in skeletally mature patients, the TSRH® Spina! System is indicated for one or more of the following: (1) degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies), (2) degenerative spondylolisthesis with objective evidence of neurologic impairment, (3) fracture, (4) dislocation, (5) scoliosis, (6) kyphosis, (7) spinal tumor, and/or (8) failed previous fusion (pseudarthrosis).

In addition, when used as a pedicle screw fixation system, the TSRH® Spinal System is indicated for skeletally mature patients: (1) having severe spondylolisthesis (Grades 3 and 4) of the fifth lumbar-first sacral (L5-S1) vertebral joint: (2) who are receiving fusions using autogenous bone graft only: (3) who are having the device fixed or attached to the lumbar and sacral spine (L3 and below); and (4) who are having the device removed after the development of a solid fusion mass.

When used as a posterior, non-cervical, non-pedicle screw fixation system, the TSRH® Spinal System is intended for the following indications: (1) degenerative disc disease (as defined by back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies), (2) spondylolisthesis, (3) fracture, (4) spinal deformities (i.e., scoliosis, kyphosis, and/or lordosis), (5) spinal stenosis, (6) pseudarthrosis, (7) tumor resection, and/or (8) unsuccessful previous attempts at spinal fusion.

For anterior use only the TSRH® Spinal System has the additional indications of: (1) spinal stenosis and/or, (2) spondylolysis

The TSRH® Spinal System is intended to help provide immobilization of spinal segments as an adjunct to fusion of the thoracic, lumbar, and/or sacral spine. The TSRH® Spinal System consists of a variety of shapes and sizes of rods, hooks, screws, cross connectors, and connecting components. In addition, GDLH® rods, DYNALOK® PLUS bolts, CD HORIZON® Low Profile MULTI-SPAN® CROSSLINK® Plates, GDLH® rod/bolt connectors, GDLH® Variable Angle T-Bolts, and GDLH® and CD HORIZON® set screws and locking screws may be used with the TSRH® Spinal System. The TSRH® Spinal System implant components can be rigidly locked into a variety of configurations, with each construct being tailor-made for the individual case. The hooks are intended for posterior use only and the staples are for anterior use only. The TSRH-3D® connectors and TSRH-3D® screws are intended for posterior use only. The TSRH® Spinal System components are fabricated from stainless steel. Alternatively, they may be fabricated from medical grade titanium alloy or medical grade titanium. The TSRH® Spinal System may be sold sterile or non-sterile.

This document is a 510(k) summary for the TSRH® Spinal System, outlining its re-submission to add modified connectors. It does not contain information about acceptance criteria or specific studies demonstrating device performance against such criteria. Instead, it focuses on arguing for "substantial equivalence" to previously cleared devices without requiring new clinical testing.

Therefore, most of your requested information cannot be extracted from this document, as it explicitly states "This submission reflects merely a wording change and therefore no additional testing is required."

Here's a breakdown of what can and cannot be answered based on the provided text:

1. A table of acceptance criteria and the reported device performance

• Cannot be provided. The document states "no additional testing is required" because the submission is for a "wording change" and modified connectors, which do not "alter the safety and effectiveness of the device." Therefore, no new performance data or acceptance criteria are presented for this specific submission. The established performance and safety are implicitly linked to the predicate devices.

2. Sample sized used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

• Cannot be provided. No new test set data was generated or used for this submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

• Cannot be provided. No new test set data was generated or used for this submission, and therefore no ground truth establishment exercise is described.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

• Cannot be provided. No new test set data was generated or used for this submission.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

• Cannot be provided. This document concerns a spinal implant system, not an AI-assisted diagnostic tool.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done

• Cannot be provided. This document concerns a spinal implant system, not an algorithm.

7. The type of ground truth used (expert concensus, pathology, outcomes data, etc)

• Cannot be provided. No new ground truth was established for this submission. The safety and effectiveness are established through substantial equivalence to predicate devices, which would have had prior clinical data or engineering tests.

8. The sample size for the training set

• Cannot be provided. No "training set" in the context of an algorithm or machine learning is relevant to this device submission.

9. How the ground truth for the training set was established

• Cannot be provided. No "training set" in the context of an algorithm or machine learning is relevant to this device submission.

Summary of the document's relevance to your questions:

The document clearly states that "no additional testing is required" for this specific 510(k) submission (K062807). The basis for clearance is "wording change" in the indications for use and modified connectors, and the assertion that these changes "do not alter the safety and effectiveness of the device." The submission relies on "substantial equivalence" to previously cleared predicate devices (K030033 and K052151). Therefore, the information you're requesting regarding new studies, acceptance criteria, sample sizes, and expert adjudications is not present in this document because such studies were explicitly deemed unnecessary for this submission.

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