K Number
K043548
Device Name
BLACKSTONE UNITY ANTERIOR LUMBAR PLATE FIXATION SYSTEM
Date Cleared
2005-06-14

(173 days)

Product Code
Regulation Number
888.3060
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Blackstone Unity™ Anterior Lumbar Plate Fixation System is indicated for use as an anteriorly placed supplemental fixation device for the lumbosacral (LS-S1) level below the bifurcation of the vascular structures. When properly used, this system will help provide temporary stabilization until a solid spinal fusion develops. Specific indications include: - a) Degenerative disc disease (defined as back pain of discogenic origin with degenerative disc confirmed by history and radiographic studies) - b) Pseudoarthrosis - c) Spondylolysis - d) Spondylolisthesis - e) Fracture - f) Neoplastic disease - g) Unsuccessful previous fusion surgery - h) Lordotic deformities of the spine - i) Idiopathic thoracolumbar or lumbar scoliosis - i) Deformity (i.e., scoliosis, and/or lordosis) associated with deficient posterior elements such as that resulting from laminectomy, spina bifida, or myelomenigocele - k) Neuromuscular deformity (i.e., scoliosis, and/or kyphosis) associated with pelvic obliquity
Device Description
The Blackstone Unity™ Anterior Lumbar Plate Fixation System is comprised of non-sterile, single use, titanium alloy components. The system is designed for use as a supplemental fixation device for the lumbosacral level, below the bifurcation of the vascular structures. The components are offered in a variety of sizes in order to accommodate specific needs during surgery.
More Information

Not Found

No
The 510(k) summary describes a mechanical spinal fixation system and contains no mention of AI, ML, image processing, or data sets typically associated with AI/ML device descriptions.

Yes
The device is indicated for use in treating various medical conditions of the spine, such as degenerative disc disease, fracture, and scoliosis, to provide temporary stabilization until spinal fusion develops. This aligns with the definition of a therapeutic device as something used to treat or alleviate a disease or condition.

No

This device is described as "an anteriorly placed supplemental fixation device" and a "temporary stabilization" system for spinal fusion. Its purpose is to physically stabilize the spine, not to diagnose conditions.

No

The device description explicitly states it is comprised of "non-sterile, single use, titanium alloy components," which are physical hardware components.

No, 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 and Intended Use: The Blackstone Unity™ Anterior Lumbar Plate Fixation System is a surgical implant designed to provide mechanical stabilization to the spine. It is a physical device used within the body during surgery, not a test performed on a sample outside the body.

The provided information clearly describes a medical device used for surgical fixation, not for diagnostic testing of biological samples.

N/A

Intended Use / Indications for Use

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is indicated for use as an anteriorly placed supplemental fixation device for the lumbosacral (L5-S1) level below the bifurcation of the vascular structures.

When properly used, this system will help provide temporary stabilization until a solid spinal fusion develops. Specific indications include:

  • a) Degenerative disc disease (defined as back pain of discogenic origin with degenerative disc confirmed by history and radiographic studies)
  • b) Pseudoarthrosis
  • c) Spondylolysis
  • d) Spondylolisthesis
  • e) Fracture
  • f) Neoplastic disease
  • g) Unsuccessful previous fusion surgery
  • h) Lordotic deformities of the spine
  • i) Idiopathic thoracolumbar or lumbar scoliosis
  • i) Deformity (i.e., scoliosis, and/or lordosis) associated with deficient posterior elements such as that resulting from laminectomy, spina bifida, or myelomenigocele
  • k) Neuromuscular deformity (i.e., scoliosis, and/or kyphosis) associated with pelvic obliquity

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

KWQ

Device Description

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is comprised of non-sterile, single use, titanium alloy components. The system is designed for use as a supplemental fixation device for the lumbosacral level, below the bifurcation of the vascular structures. The components are offered in a variety of sizes in order to accommodate specific needs during surgery.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lumbosacral (L5-S1) level below the bifurcation of the vascular structures

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.

K013665

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

K043548
102

JUN 1 4 2005

Premarket Notification 510(k) Blackstone Medical, Inc. Blackstone™ Unity™ Anterior Lumbar Plate Fixation System.

510(K) SUMMARY

| Name of Firm: | Blackstone Medical, Inc.
90 Brookdale Drive
Springfield, MA 01104 |
|------------------------------------------|------------------------------------------------------------------------------|
| 510(k) Contact: | Dean E. Ciporkin
Director, Regulatory Affairs and Quality Assurance |
| Trade Name: | Blackstone™ Unity™ Anterior Lumbar Plate Fixation System |
| Common Name: | Spinal Intervertebral Body Fixation Orthosis |
| Device Product Code
& Classification: | KWQ-888.3060 - Appliance, Fixation, Spinal Intervertebral Body |
| Substantially
Equivalent Devices: | Medtronic Sofamor Danek
Pyramid™ Anterior Plate Fixation System (K013665) |

Device Description:

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is comprised of non-sterile, single use, titanium alloy components. The system is designed for use as a supplemental fixation device for the lumbosacral level, below the bifurcation of the vascular structures. The components are offered in a variety of sizes in order to accommodate specific needs during surgery.

1

Intended Use / Indications for Use:

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is indicated for use as an anteriorly placed supplemental fixation device for the lumbosacral (LS-S1) level below the bifurcation of the vascular structures.

When properly used, this system will help provide temporary stabilization until a solid spinal fusion develops. Specific indications include:

  • a) Degenerative disc disease (defined as back pain of discogenic origin with degenerative disc confirmed by history and radiographic studies)
  • b) Pseudoarthrosis
  • c) Spondylolysis
  • d) Spondylolisthesis
  • e) Fracture
  • f) Neoplastic disease
  • g) Unsuccessful previous fusion surgery
  • h) Lordotic deformities of the spine
  • i) Idiopathic thoracolumbar or lumbar scoliosis
  • i) Deformity (i.e., scoliosis, and/or lordosis) associated with deficient posterior elements such as that resulting from laminectomy, spina bifida, or myelomenigocele
  • k) Neuromuscular deformity (i.e., scoliosis, and/or kyphosis) associated with pelvic obliquity

Basis of Substantial Equivalence:

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is substantially equivalent to the Medtronic Sofamor Danek Pyramid™ Anterior Plate Fixation System (K013665), which has been cleared by FDA for use as a fixation device.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized caduceus, a symbol often associated with medicine and healthcare, consisting of a staff with two snakes coiled around it and wings at the top. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES . USA" is arranged in a circular pattern around the caduceus.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 1 4 2005

Mr. Dean E. Ciporkin Director Regulatory Affairs and Quality Assurance Blackstone Medical Incorporated 90 Brookdale Drive Springfield, MA 01104

Re: K043548

Trade/Device Name: UNITY Anterior Lumbar Plate System Regulation Number: 888.3060 Regulation Name: Spinal Intervertebral Body Fixation Orthosis Regulatory Class: Class II Product Code: KWQ Dated: May 25, 2005 Received: May 26, 2005

Dear Mr. Ciporkin:

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.

3

Page 2 - Mr. Dean E. Ciporkin

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that I Dri s issuated or a badevice complies with other requirements of the Act mail i Dri has made a dolor mexulations administered by other Federal agencies. You must of any reach statutes and regulations and limited to: registration and listing (21 Comply with an the Her of equinements, and manufacturing practice requirements as set OI It I art 607); idoomig (21 CFR Part 820); and if applicable, the electronic forth in the quality systems (Sections 531-542 of the Act); 21 CFR 1000-1050. product faction control pro risions (2001). "We'll be as described in your Section 510(k) I mis letter will anow you to begin manceing of substantial equivalence of your device to a legally prematication: The PDA maining of Eastification 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), please If you desire specific acrice ior your as (240) 276-0120. Also, please note the regulation entitled, Comact the Oriece of Compuner in (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small other general international and Consumer Assistance at its toll-free number (800) 638-2041 or Manufacturers; internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Hyat Rurder

Miriam Provost, Ph.D. Acting Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known):

Device Name: Blackstone™ Unity™ Anterior Lumbar Plate Fixation System

Indications for Use:

The Blackstone Unity™ Anterior Lumbar Plate Fixation System is indicated for use as an anteriorly placed supplemental fixation device for the lumbosacral (L5-S1) level below the bifurcation of the vascular structures.

When properly used, this system will help provide temporary stabilization until a solid spinal fusion develops. Specific indications include:

  • a) Degenerative disc disease (defined as back pain of discogenic origin with degenerative disc confirmed by history and radiographic studies)
  • b) Pseudoarthrosis
  • c) Spondylolysis
  • d) Spondylolisthesis
  • e) Fracture
  • Neoplastic disease f)
  • g) Unsuccessful previous fusion surgery
  • h) Lordotic deformities of the spine
  • Idiopathic thoracolumbar or lumbar scoliosis i)
  • Deformity (i.e., scoliosis, and/or lordosis) associated with deficient i) posterior elements such as that resulting from laminectomy, spina bifida, or mvelomenigocele
  • k) Neuromuscular deformity (i.e., scoliosis, and/or kyphosis) associated with pelvic obliquity

Prescription Use × (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off)
Division of General, Restorative,
and Neurological Devices
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510(k) Number K0933548

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