K Number
K022399
Device Name
BLACKSTONE SPINAL FIXATION SYSTEM SPACER
Date Cleared
2002-08-06

(14 days)

Product Code
Regulation Number
888.3060
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Blackstone Spinal Fixation System is intended for non-cervical use in the spine. The Blackstone Spinal Fixation System, when used for pedicle screw fixation, is intended only for patients: a) Having severe spondylolisthesis (Grades 3 and 4) at the L5-S1 joint; b) Who are receiving fusion using autogenous bone graft only; c) Who are having the device fixed or attached to the lumbar and sacral spine (L3 and below); and d) Who are having the device removed after the development of a solid fusion mass. The Blackstone Spinal Fixation System, when used as a pedicle screw system in skeletally mature patients, is intended to provide immobilization and stabilization of spinal segments, as an adjunct to fusion, in treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar and sacral spine: a) Degenerative spondylolisthesis with objective evidence of neurologic impairment; b) Fracture; c) Dislocation; d) Scoliosis; e) Kyphosis; f) Spinal tumor; and g) Failed previous fusion (pseudarthrosis). The Blackstone Spinal Fixation System, when used for anterolateral non-pedicle fixation, is intended for the following indications: a) Degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies); b) Spinal stenosis; c) Spondylolisthesis; d) Spinal deformities (i.e., scoliosis, kyphosis, and/or lordosis); e) Pseudarthrosis; f) Tumor; g) Trauma (i.e., fracture or dislocation); h) Previous failed fusion.
Device Description
The Blackstone™ Spinal Fixation System Spacer (System Modification) is a titanium alloy (6AL-4V ELI, per ASTM F136) device, which is a non-sterile, single use component. This device is an adjunct to the Spinal Fixation System, which allows a surgeon to build a spinal implant construct. The system's design is intended to stabilize the spinal operative site during the fusion process of a bone graft in the disc space. The device added to the current Spinal Fixation System is listed below with a brief description. Spacer: The Spacer is available in one diameter and two thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Spacer has a spherical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components.
More Information

Not Found

No
The description focuses on the mechanical components and intended use of a spinal fixation system, with no mention of software, algorithms, or data processing that would indicate AI/ML.

Yes

The device is intended to provide immobilization and stabilization of spinal segments, as an adjunct to fusion, in treatment of various acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine, which are therapeutic interventions.

No

The document describes a spinal fixation system, which is a medical device used for surgical implantation, not for diagnosing medical conditions.

No

The device description explicitly states it is a titanium alloy hardware device (Spacer) and an adjunct to a Spinal Fixation System, which are physical implants.

Based on the provided text, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device description: The Blackstone Spinal Fixation System is a physical implant made of titanium alloy intended for surgical implantation in the spine. It is used to stabilize spinal segments.
  • Intended Use: The intended use describes the surgical procedures and conditions for which the device is used to provide structural support and stabilization within the body.

The device is a surgical implant, not a test performed on a sample outside the body.

N/A

Intended Use / Indications for Use

Blackstone Spinal Fixation System is intended for non-cervical use in the spine.

The Blackstone Spinal Fixation System, when used for pedicle screw fixation, is intended only for patients:

  • a) Having severe spondylolisthesis (Grades 3 and 4) at the L5-S1 joint;
  • b) Who are receiving fusion using autogenous bone graft only;
  • c) Who are having the device fixed or attached to the lumbar and sacral spine (L3 and below); and
  • d) Who are having the device removed after the development of a solid fusion mass.

The Blackstone Spinal Fixation System, when used as a pedicle screw system in skeletally mature patients, is intended to provide immobilization and stabilization of spinal segments, as an adjunct to fusion, in treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar and sacral spine:

  • a) Degenerative spondylolisthesis with objective evidence of neurologic impairment;
  • b) Fracture;
  • c) Dislocation:
  • d) Scoliosis;
  • e) Kyphosis:
  • f) Spinal tumor; and
  • g) Failed previous fusion (pseudarthrosis).

The Blackstone Spinal Fixation System, when used for anterolateral non-pedicle fixation, is intended for the following indications:

  • a) Degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies);
  • b) Spinal stenosis;
  • c) Spondylolisthesis:
  • d) Spinal deformities (i.e., scoliosis, kyphosis, and/or lordosis);
  • e) Pseudarthrosis;
  • f) Tumor;
  • g) Trauma (i.e., fracture or dislocation);
  • h) Previous failed fusion.

Product codes (comma separated list FDA assigned to the subject device)

MNH 888.3070, KWQ 888.3060, MNI 888.3070

Device Description

The Blackstone™ Spinal Fixation System Spacer (System Modification) is a titanium alloy (6AL-4V ELI, per ASTM F136) device, which is a non-sterile, single use component. This device is an adjunct to the Spinal Fixation System, which allows a surgeon to build a spinal implant construct. The system's design is intended to stabilize the spinal operative site during the fusion process of a bone graft in the disc space. The device added to the current Spinal Fixation System is listed below with a brief description.

Spacer:
The Spacer is available in one diameter and two thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Spacer has a spherical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components.

The Spacer is available in the configurations are as follows:
Spacer 3mm thickness Spacer 5mm thickness

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

non-cervical use in the spine, L5-S1 joint, lumbar and sacral spine (L3 and below), thoracic, lumbar and sacral spine

Indicated Patient Age Range

skeletally mature patients

Intended User / Care Setting

surgeon

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K994217, K003735, K013558, K020674

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 888.3060 Spinal intervertebral body fixation orthosis.

(a)
Identification. A spinal intervertebral body fixation orthosis is a device intended to be implanted made of titanium. It consists of various vertebral plates that are punched into each of a series of vertebral bodies. An eye-type screw is inserted in a hole in the center of each of the plates. A braided cable is threaded through each eye-type screw. The cable is tightened with a tension device and it is fastened or crimped at each eye-type screw. The device is used to apply force to a series of vertebrae to correct “sway back,” scoliosis (lateral curvature of the spine), or other conditions.(b)
Classification. Class II.

0

AUG 0 6 2002

510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

| Name of Firm: | Blackstone Medical, Inc.
90 Brookdale Drive
Springfield, MA 01104 |
|------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Contact: | Alan Lombardo
Director of Engineering |
| Trade Name: | Blackstone™ Spinal Fixation System
Spacer (System Modification) |
| Common Name: | Rod and screw spinal instrumentation |
| Device Product Code
& Classification: | MNH 888.3070 - Spondylolisthesis Spinal
Fixation Device System
KWQ 888.3060 - Spinal Intervertebral Body Fixation
Orthosis
MNI 888.3070 - Pedicle Screw Spinal System |
| Substantially
Equivalent Devices: | Blackstone™ Spinal Fixation System (K994217)
Blackstone™ Spinal Fixation System Second-Gen Cross-
Connector (K003735)
Blackstone™ Spinal Fixation System 4.5mm Mono-Axial
Screws (K013558) |

Blackstone™ Spinal Fixation System 4.5mm Multi-Axial Screws (K020674)

Device Description:

The Blackstone™ Spinal Fixation System Spacer (System Modification) is a titanium alloy (6AL-4V ELI, per ASTM F136) device, which is a non-sterile, single use component. This device is an adjunct to the Spinal Fixation System, which allows a surgeon to build a spinal implant construct. The system's design is intended to stabilize the spinal operative site during the fusion process of a bone graft in the disc space. The device added to the current Spinal Fixation System is listed below with a brief description.

Spacer:

The Spacer is available in one diameter and two thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Spacer has a spherical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components. For the actual application of the device

KO22390

1

refer to the surgical technique in Appendix A, Exhibit D.

The Spacer is available in the configurations are as follows:

Spacer 3mm thickness Spacer 5mm thickness

Intended Use / Indications for Use:

Blackstone Spinal Fixation System is intended for non-cervical use in the spine.

The Blackstone Spinal Fixation System, when used for pedicle screw fixation, is intended only for patients:

  • a) Having severe spondylolisthesis (Grades 3 and 4) at the L5-S1 joint;
  • b) Who are receiving fusion using autogenous bone graft only;
  • c) Who are having the device fixed or attached to the lumbar and sacral spine (L3 and below); and
  • d) Who are having the device removed after the development of a solid fusion mass.

The Blackstone Spinal Fixation System, when used as a pedicle screw system in skeletally mature patients, is intended to provide immobilization and stabilization of spinal segments, as an adjunct to fusion, in treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar and sacral spine:

  • a) Degenerative spondylolisthesis with objective evidence of neurologic impairment;
  • b) Fracture;
  • c) Dislocation:
  • d) Scoliosis;
  • e) Kyphosis:
  • f) Spinal tumor; and
  • g) Failed previous fusion (pseudarthrosis).

The Blackstone Spinal Fixation System, when used for anterolateral non-pedicle fixation, is intended for the following indications:

  • a) Degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies);
  • b) Spinal stenosis;
  • c) Spondylolisthesis:
  • d) Spinal deformities (i.e., scoliosis, kyphosis, and/or lordosis);
  • e) Pseudarthrosis;
  • f) Tumor;
  • g) Trauma (i.e., fracture or dislocation);
  • h) Previous failed fusion.

2

K 022399

BASIS OF SUBSTANTIAL EQUIVALENCE:

The Blackstone™ Spacer is a system modification to the Blackstone™ Spinal Fixation System which has received regulatory clearance as follows:

Blackstone™ Spinal Fixation System (K994217)

Blackstone™ Spinal Fixation System Second-Gen Cross-Connector (K003735) Blackstone™ Spinal Fixation System 4.5mm Mono-Axial Screws (K013558) Blackstone™ Spinal Fixation System 4.5mm Multi-Axial Screws (K020674)

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image contains a logo for the U.S. Department of Health & Human Services. The logo features the department's emblem, which is a stylized representation of an eagle with three human profiles incorporated into its design. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the emblem. Part of the word "Page" is visible on the right side of the image.

age 1 - Mr. Alan Lombardo

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 0 6 2002

Mr. Alan Lombardo Director, Engineering Blackstone Medical, Inc. 90 Brookdale Drive Springfield, Massachusetts 01104

Re: K022399

Trade/Device Name: Blackstone Spinal Fixation System Spacer Regulation Number: 21 CFR 888.3060, 888.3070 Regulation Name: Spinal intervetebral body fixation orthosis; spondylolisthesis spinal fixation device system; pedicle screw spinal system Regulatory Class: Class II Product Code: KWQ, MNH, MNI Dated: July 22, 2002 Received: July 23, 2002

Dear Mr. Lombardo:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration. Iisting of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA). it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA mav publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

4

Page 2 - Mr. Alan Lombardo

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4659. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours.

Sincerely yours,

Mark N. Milburn

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Indications for Use:

Blackstone Spinal Fixation System is intended for non-cervical use in the spine.

The Blackstone Spinal Fixation System, when used for pedicle screw fixation, is intended only for patients:

  • a) Having severe spondylolisthesis (Grades 3 and 4) at the L5-S1 joint;
  • b) Who are receiving fusion using autogenous bone graft only;
  • c) Who are having the device fixed or attached to the lumbar and sacral spine (L3 and below); and
  • d) Who are having the device removed after the development of a solid fusion mass.

The Blackstone Spinal Fixation System, when used as a pedicle screw system in skeletally mature patients, is intended to provide immobilization and stabilization of spinal segments, as an adjunct to fusion, in treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar and sacral spine:

a) Degenerative spondylolisthesis with objective evidence of neurologic impairment;

  • b) Fracture:
  • c) Dislocation;
  • d) Scoliosis;
  • e) Kyphosis:
  • f) Spinal tumor; and
  • g) Failed previous fusion (pseudarthrosis).

The Blackstone Spinal Fixation System, when used for anterolateral non-pedicle fixation, is intended for the following indications:

  • a) Degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies);
  • b) Spinal stenosis;
  • c) Spondylolisthesis;
  • d) Spinal deformities (i.e., scoliosis, kyphosis, and/or lordosis);
  • e) Pseudarthrosis;
  • f) Tumor;
  • g) Trauma (i.e., fracture or dislocation);
  • h) Previous failed fusion.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

f Mark
Sohcurrence of CDRH, Office of Device Evaluation (ODE)
Division Sien om

Division Sign-Off) Division of General, Restorative and Neurological Devices

510(k) Number_