K Number
K022605
Device Name
BLACKSTONE SPINAL FIXATION SYSTEM STAPLE & WASHER
Date Cleared
2002-08-21

(15 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 anterolateral screw/staple fixation of the T6-L5 spine, is intended for the following indications: - a) Degenerative disc disease (ddd) this should be defined. Based on the 5/23/96 Panel meeting, ddd should be defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. - b) Spondylolisthesis - c) Trauma (i.e., fracture or dislocation) - d) Spinal stenosis; - e) Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis) - f) Tumor - g) Pseudarthrosis - h) Previous failed fusion.
Device Description
The Blackstone™ Spinal Fixation System Staple & Washer (System Modification) are titanium alloy (6AL-4V ELI, per ASTM F136) devices, which are non-sterile, single use components. These devices are 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 devices added to the current Spinal Fixation System are listed below with a brief description. Staple: The Staple is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Staple has a conical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components. Furthermore, the device has three prongs with a trocar tip which fix's the device to a vertebral body. Washer: The Washer is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Washer has a conical 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 summary describes a mechanical spinal fixation system made of titanium alloy components (staples and washers) and does not mention any software, algorithms, or AI/ML capabilities.

Yes
The device is described as an "adjunct to the Spinal Fixation System, which allows a surgeon to build a spinal implant construct" and its design is "intended to stabilize the spinal operative site during the fusion process of a bone graft in the disc space," which indicates a therapeutic purpose. Furthermore, its intended uses include treating medical conditions like degenerative disc disease, spondylolisthesis, and trauma, all of which fall under the scope of therapeutic applications.

No

The device description indicates it is a spinal fixation system, consisting of implants (staples and washers) used to stabilize the spine during fusion. It does not mention any function related to diagnosing conditions.

No

The device description explicitly states it is comprised of titanium alloy hardware components (Staple and Washer) intended for surgical implantation.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, treatment, or prevention of disease.
  • Device Description: The Blackstone Spinal Fixation System is a system of implants (staples and washers) made of titanium alloy. These are physical devices implanted into the spine to provide stabilization during the fusion process.
  • Intended Use: The intended use is for spinal fixation in non-cervical regions for various spinal conditions. This involves surgical implantation and mechanical support, not the analysis of biological specimens.

The description clearly indicates a surgical implant system, not a diagnostic test performed on samples 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 anterolateral screw/staple fixation of the T6-L5 spine, is intended for the following indications:

  • a) Degenerative disc disease (ddd) this should be defined. Based on the 5/23/96 Panel meeting, ddd should be defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies.
  • b) Spondylolisthesis
  • c) Trauma (i.e., fracture or dislocation)
  • d) Spinal stenosis;
  • e) Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis)
  • f) Tumor
  • g) Pseudarthrosis
  • h) Previous failed fusion.

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

KWQ

Device Description

The Blackstone™ Spinal Fixation System Staple & Washer (System Modification) are titanium alloy (6AL-4V ELI, per ASTM F136) devices, which are non-sterile, single use components. These devices are 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 devices added to the current Spinal Fixation System are listed below with a brief description.

Staple:

The Staple is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Staple has a conical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components. Furthermore, the device has three prongs with a trocar tip which fix's the device to a vertebral body. For the actual application of the device refer to the surgical technique in Appendix C, Exhibit I.

The Staple is available in the configurations are as follows:
Spacer 2mm thickness Spacer 4mm thickness Spacer 6mm thickness

Washer:

The Washer is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Washer has a conical 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 refer to the surgical technique in Appendix C, Exhibit I.

The Washer is available in the configurations are as follows:
Spacer 2mm thickness Spacer 4mm thickness Spacer 6mm 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, T6-L5 spine

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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 2 1 2002

page 1 of 3

KOZZ605

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
Staple & Washer (System Addition) |
| Common Name: | Rod and screw spinal instrumentation |
| Device Product Code & Classification: | KWQ 888.3060 - Spinal Intervertebral Body Fixation
Orthosis |
| 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 Screw (K020674) |

Device Description:

The Blackstone™ Spinal Fixation System Staple & Washer (System Modification) are titanium alloy (6AL-4V ELI, per ASTM F136) devices, which are non-sterile, single use components. These devices are 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 devices added to the current Spinal Fixation System are listed below with a brief description.

Staple:

The Staple is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Staple has a conical recess feature, which allows the head of a pedicle screw to nest in it for congruent contact between components. Furthermore, the device has three prongs with a trocar tip which fix's the device to a vertebral body. For the

1

page 2 of 3

K022605

actual application of the device refer to the surgical technique in Appendix C, Exhibit I.

The Staple is available in the configurations are as follows:

Spacer 2mm thickness Spacer 4mm thickness Spacer 6mm thickness

Washer:

The Washer is available in one diameter and three thicknesses. This device may be required in various clinical applications, as determined by a qualified surgeon. The Washer has a conical 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 refer to the surgical technique in Appendix C, Exhibit I.

The Washer is available in the configurations are as follows:

Spacer 2mm thickness Spacer 4mm thickness Spacer 6mm 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 anterolateral screw/staple fixation of the T6-L5 spine, is intended for the following indications:

  • a) Degenerative disc disease (ddd) this should be defined. Based on the 5/23/96 Panel meeting, ddd should be defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies.
  • b) Spondylolisthesis
  • c) Trauma (i.e., fracture or dislocation)
  • d) Spinal stenosis;
  • e) Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis)
  • f) Tumor
  • g) Pseudarthrosis
  • h) Previous failed fusion.

2

K022605

Page 3 of 3

BASIS OF SUBSTANTIAL EQUIVALENCE:

The Blackstone™ Staple & Washer 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)

510(k) Number:

Device Name: Blackstone™ Spinal Fixation System

Summary

3

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle or bird symbol with three lines forming its head and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the bird symbol.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 2 1 2002

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

Re: K022605

Trade/Device Name: Blackstone™ Spinal Fixation System Staple and Washer Regulation Number: 21 CFR 888.3060 Regulation Name: Spinal intervertebral body fixation orthosis Regulatory Class: Class II Product Code: K WQ Dated: August 2, 2002 Received: August 6, 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, listing 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 may 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

Paqe 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) 594-4539. 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.

R. Mark N. Millersen

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

K022605 page 1 of 1

Indications for Use:

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

The Blackstone Spinal Fixation System, when used for anterolateral screw/staple fixation of the T6-L5 spine, is intended for the following indications:

a) Degenerative disc disease (ddd) -- this should be defined. Based on the 5/23/96 Panel meeting, ddd should be defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies.

b) Spondylolisthesis

c) Trauma (i.e., fracture or dislocation)

d) Spinal stenosis;

  • e) Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis)
    f) Tumor

g) Pseudarthrosis

h) Previous failed fusion.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use

OR

Over-The-Counter Use

(Per 21 CFR801.109

Mark A. Mellecker

Division of General. Restorative and Neurological Devices

510(k) Number

KO 2266