Horizontal-Vertical Lumbar Valve Systems are implantable devices used in the treatment of patients with communicating hydrocephalus to shunt cerebrospinal fluid (CSF) from the lumbar subarachnoid region to the peritoneal cavity. They provide controlled intraventricular pressure and CSF drainage in patients with hydrocephalus. The antechamber can be electively mounted in line with the Valve Unit to allow for CSF sampling or injections in the subarachnoid space.

Percutaneous lumbar peritoneal shunting may be utilized in the treatment of communicating hydrocephalus. It is designed to shunt CSF from the lumbar subarachnoid space to the peritoneal cavity.

The shunt may be used for diagnosis, evaluation or treatment of normal pressure communicating hydrocephalus.

A percutaneous lumbar peritoneal shunt is also useful in the management of persistent cerebrospinal fluid fistulas, bulging cranial and suboccipital decompressions and in transient CSF absorption defects, e.g. post-meningitic or post-hemorrhagic hydrocephalus.

The In-Line Valve, available as a separate component of the system, is indicated for use where added resistance is desired to alleviate symptoms of low pressure in the small percentage of patients who, after normal drainage and in the normal course of treatment, develop such symptoms.

Device Description

The Horizontal-Vertical Lumbar Valve and the Spetzler Lumbar-Peritoneal Shunt systems are implantable devices used in the treatment of patients with communicating hydrocephalus to shunt cerebrospinal fluid (CSF) from the lumbar subarachnoid region to the peritoneal cavity. Both are differential pressure valves designed to open when the difference between ventricular or lumbar pressure and outlet cavity pressure exceeds a certain threshold.

AI/ML Overview

The Integra LifeSciences K101381 submission describes the Horizontal-Vertical Lumbar Valve Systems and Spetzler Lumbar Peritoneal Shunt Systems, which are implantable devices for shunting cerebrospinal fluid. The submission focuses on adding MRI safety information to the labeling, classifying the devices as "MR Conditional."

Here's an analysis of the acceptance criteria and the study that proves the device meets them:

1. Table of Acceptance Criteria and Reported Device Performance:

Design Verification Test	Acceptance Criteria	Reported Device Performance
Visual Inspection	All test samples shall be complete and free of visible damage.	(Not explicitly stated for the "reported device performance" section, but the overall conclusion implies compliance.) The non-clinical testing demonstrated the devices are MR Conditional.
Magnetically Induced Displacement Force Test (ASTM F2052)	The amount of magnetically induced force on the device shall be less than or equal to the force on the device due to gravity.	"Integra NeuroSciences tests indicate that MRI exposure does not affect pressure valve settings. No significant forces or temperature changes were noticed during MRI exposure." (From the comparison table for the predicate device, which is stated to be identical.) This directly implies that the displacement force criterion was met.
Magnetically Induced Torque Test (ASTM F2213)	The amount of magnetically induced torque on the device shall be less than or equal to the gravitational torque.	"Integra NeuroSciences tests indicate that MRI exposure does not affect pressure valve settings. No significant forces or temperature changes were noticed during MRI exposure." (From the comparison table for the predicate device, which is stated to be identical.) This directly implies that the torque criterion was met.
RF Heating Test (ASTM F2182)	No portion of the implanted device shall exhibit an increase in temperature of more than 2°C at a SAR of 2W/kg.	"Integra NeuroSciences tests indicate that MRI exposure does not affect pressure valve settings. No significant forces or temperature changes were noticed during MRI exposure." (From the comparison table for the predicate device, which is stated to be identical.) This directly implies that the temperature increase criterion was met.
Image Artifact Test (ASTM F2119)	There is no acceptance criterion as per ASTM standard; this test is performed to gather information relating to image artifacts caused by the device. This information can be included in labeling.	The test was performed to gather information. (No specific numerical performance is required or reported for this test, as per the acceptance criteria itself. The intent is to provide information for labeling.) The non-clinical testing demonstrated the devices are MR Conditional, implying this information was gathered and would be included in the labeling.

Summary of Device Performance: The non-clinical testing, which included the tests listed above, demonstrated that the Horizontal-Vertical Lumbar Valve Systems and Spetzler Lumbar Peritoneal Shunt Systems are MR Conditional, as defined in the ASTM 2503-05 Standard. This classification signifies that the devices pose "no known hazards in specific MR environment with specified conditions."

2. Sample Size Used for the Test Set and the Data Provenance:

Sample Size: The document does not specify the exact number of devices or components used for each of the non-clinical tests (Magnetically Induced Displacement Force, Torque, RF Heating, Image Artifact). It only refers to "All test samples" for visual inspection and "the device" for the other tests.
Data Provenance: The testing was conducted by "Integra NeuroSciences" which indicates the tests were performed internally by the manufacturer. The data is from non-clinical bench testing, not from human subjects. The country of origin is not explicitly stated for the testing, but Integra LifeSciences is based in Plainsboro, NJ, USA. The data is prospective in the sense that the tests were performed specifically for this submission to support the MR Conditional claim.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and the Qualifications of Those Experts:

This submission did not involve a test set requiring human expert ground truth. The "ground truth" for these tests are the objective physical measurements and adherence to ASTM standards regarding magnetic forces, heating, and image artifacts. These are quantifiable engineering and physics measurements.

4. Adjudication Method for the Test Set:

Not applicable, as this was non-clinical bench testing involving objective measurements against defined standards, not subjective assessments requiring expert consensus or adjudication. The results would be objectively measured and compared to the predefined acceptance criteria.

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:

Not applicable. This submission is for medical devices (shunt systems) and focuses on their physical properties and safety in an MR environment, not on an AI-powered diagnostic or assistive tool. Therefore, an MRMC study related to human reading improvement with AI is irrelevant here.

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

Not applicable. This is not an algorithm or AI-powered device.

7. The Type of Ground Truth Used:

The "ground truth" for this non-clinical testing comprises:

Defined ASTM standards (ASTM F2052, ASTM F2213, ASTM F2182, ASTM F2119, ASTM 2503-05).
Objective physical measurements of magnetic force, torque, temperature increase, and observation of image artifacts, performed according to these standards.
The criterion for MR Conditional classification ("no known hazards in specific MR environment with specified conditions").

8. The Sample Size for the Training Set:

Not applicable. This is not an AI/machine learning device that requires a training set. The devices are physical medical implants.

9. How the Ground Truth for the Training Set Was Established:

Not applicable, as there is no training set for this type of device.

Summary

{0}------------------------------------------------

K101381

Image /page/0/Picture/1 description: The image shows the word "INTEGRA" in bold, black letters. Below the word "INTEGRA" is the phrase "LIMIT UNCERTAINTY" in smaller, black letters. To the right of the word "INTEGRA" is a design of four black squares of different sizes stacked on top of each other.

510(k) Summary

JUL - 7 2011

1. Contact Details

Applicant Name: Integra LifeSciences Corporation 311 Enterprise Drive Plainsboro, NJ 08536, USA Telephone: (609) 654-2873 Facsimile: (609) 275-9445

Contact Person: Donna Millisky Manager, Regulatory Affairs E-Mail: donna.millisky@integralife.com

Date Prepared: June 23, 2011

2. Device Name

Horizontal-Vertical Lumbar Valve Systems Tradename: Spetzler™ Lumbar Peritoneal Shunt Systems

Common Name: Hydrocephalus Shunts

Classification Name: Shunt, Central Nervous System and Components, JXG

3. Legally Marketed Predicate Device(s)

510(k) Number	Product Code	Trade Name	Manufacturer
K944595	JXG	Cordis Horizontal-VerticalValve System	Integra LifeSciences(Previously Cordis Corp.)
K811288	JXG	Spetzler Lumbar-PeritonealSystems	Integra LifeSciences(Previously AmericanHeyer-Schulte Corp.)
K871685	JXG	Heyer-Schulte SpetzlerLumbar-Peritoneal ShuntSystems	Integra LifeSciences(Previously AmericanHeyer-Schulte Corp.)

{1}------------------------------------------------

4. Device Description

The primary issues affecting the safety and compatibility of passive implants in the MR environment concern magnetically induced displacement force and torque, radio frequency (RF) heating, and image artifacts. The addition of MRI Safety information to the labeling is intended to provide for safe use of the shunt systems by clarifying the conditions required to safely use these devices in an MR environment in a readily available, clear and concise manner, to healthcare providers.

5. Intended Use/Indications for use

Horizontal-Vertical Lumbar Valve Systems

Spetzler Lumbar Peritoneal Shunt Systems

Percutaneous lumbar peritoneal shunting may be utilized in the treatment of communicating hydrocephalus. The Spetzler Shunt systems are designed to shunt CSF from the lumbar subarachnoid space to the peritoneal cavity.

The shunt may be used for diagnosis, evaluation or treatment of normal pressure communicating hydrocephalus.

{2}------------------------------------------------

6. Substantial Equivalence Comparison

The Horizontal-Vertical Lumbar Valve and the Spetzler Lumbar-Peritoneal Shunt systems are identical to currently marketed predicate Horizontal-Vertical Lumbar Valve and Spetzler Lumbar-Peritoneal Shunt systems except for a labeling revision to add MRI safety information for the safe use of the devices in an MR environment.

Feature	Predicate Horizontal-VerticalLumbar Valve System (K944595)	Horizontal-Vertical LumbarValve System
Indications for Use	Implantable system used in the treatment of patients with communicating hydrocephalus, to shunt CSF from the lumbar subarachnoid region to the peritoneal cavity.	Same as Predicate Horizontal-Vertical Lumbar Valve System
Incorporates the same basic design and utilizes the same operating principle	Differential pressure valve with two balls in cone valve mechanisms: a spring actuated (lower) pressure mechanism and a gravity-actuated (higher) pressure mechanism. Flow direction identified by an arrow on the stainless steel modulus	Same as Predicate Horizontal-Vertical Lumbar Valve System
Performance Specifications	Six pressure ranges with closing pressures between 50 and 125 mmH2O in the horizontal position and between 170 and 445 mmH2O in the vertical position.	Same as Predicate Horizontal-Vertical Lumbar Valve System
MRI Safe	Integra NeuroSciences tests indicate that MRI exposure does not affect pressure valve settings. No significant forces or temperature changes were noticed during MRI exposure.	MR Conditional
Biocompatible	Yes	Same as Predicate Horizontal-Vertical Lumbar Valve System
Feature	Predicate Spetzler LumbarPeritoneal Shunt Systems(K811288 and K871685)	Spetzler Lumbar PeritonealShunt Systems
Indications for Use	Percutaneous lumbar peritonealshunting may be utilized in thetreatment of communicatinghydrocephalus. It is designed toshunt CSF from the lumbarsubarachnoid space to theperitoneal cavity.	Same as Predicate SpetzlerLumbar Peritoneal ShuntSystems
	The shunt may be used fordiagnosis, evaluation or treatmentof normal pressure communicatinghydrocephalus.
	A percutaneous lumbar peritonealshunt is also useful in themanagement of persistentcerebrospinal fluid fistulas, bulgingcranial and suboccipitaldecompressions and in transientCSF absorption defects, e.g. post-meningitic or post-hemorrhagichydrocephalus.
	The In-Line Valve, available as aseparate component of the system,is indicated for use where addedresistance is desired to alleviatesymptoms of low pressure in thesmall percentage of patients who,after normal drainage and in thenormal course of treatment, developsuch symptoms.
Incorporates the samebasic design andutilizes the sameoperating principle	Pressure control is achievedthrough a combination of thedouble slit valve at the peritonealend and the small inner diametercatheter	Same as Predicate SpetzlerLumbar Peritoneal ShuntSystems
PerformanceSpecifications	Six systems with pressure rangeswith closing pressures between 50and 400 mmHgH20	Same as Predicate SpetzlerLumbar Peritoneal ShuntSystems
MRI Safe	No claim	MR Conditional
Biocompatible	Yes	Same as Predicate SpetzlerLumbar Peritoneal ShuntSystems

{3}------------------------------------------------

{4}------------------------------------------------

7. Non-Clinical Testing

The Horizontal-Vertical Lumbar Valve Systems and Spetzler Lumbar Peritoneal Shunt Systems are identical in design. performance, and materials of composition to the currently marketed predicate systems. Since the proposed shunts and accessories are identical to the currently marketed shunts and accessories, all performance testing to the performance of the predicate devices also supports the proposed devices, and remains unchanged. Additional bench testing was performed to determine the safe use conditions for these products in the MR environment, as described below. Testing was also performed to confirm that the performance of these devices remains the same after use in an MR environment.

DESIGNVERIFICATION TEST	Acceptance
Visual Inspection	All test samples shall be complete and free of visible damage.
Magnetically InducedDisplacement Force TestASTM F2052	The amount of magnetically induced force on the device shall be lessthan or equal to the force on the device due to gravity.
Magnetically InducedTorque TestASTM F2213	The amount of magnetically induced torque on the device shall beless than or equal to the gravitational torque.
RF Heating TestASTM F 2182	No portion of the implanted device shall exhibit an increase intemperature of more than 2°C at a SAR of 2W/kg.
Image Artifact TestASTM F2119	There is no acceptance criterion as per ASTM standard; this test isperformed to gather information relating to image artifacts caused bythe device. This information can be included in labeling.

The non-clinical testing has demonstrated that the Horizontal-Vertical Lumbar Valve Systems and Spetzler Lumbar Peritoneal Shunt Systems are MR Conditional, as defined in the ASTM 2503-05 Standard, "Standard Practice for Marking Medical Devices and other items for Safety in the Magnetic Resonance Environment." This classification is appropriate for "an item which has been demonstrated to pose no known hazards in specific MR environment with specified conditions.

8. Clinical Testing

Clinical testing was not applicable for this modification.

{5}------------------------------------------------

9. Conclusions

The conclusions drawn from the nonclinical testing demonstrate that both the Horizontal-Vertical Lumbar Valve Systems and the Spetzler Lumbar Peritoneal Shunt Systems, with the addition of MRI Safety information in the labeling, are as safe and effective, and perform at least as safely and effectively, as the legally marketed predicate devices.

{6}------------------------------------------------

Image /page/6/Picture/1 description: The image shows the seal of the Department of Health & Human Services USA. The seal is circular and contains the department's name around the perimeter. In the center of the seal is an abstract image of a bird-like figure with three tail feathers.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Integra Life Sciences Corporation c/o Ms. Donna Millisky Manager, Corporate Regulatory Affairs 311 Enterprise Drive Plainsboro, NJ 08536

JUL - 7 2011

Re: K101381

Trade/Device Name: Integra Horizontal-Vertical Lumbar Valve Systems and Spetzler Lumbar Peritoneal Shunt Systems Regulation Number: 21 CFR 882.5550 Regulation Name: Central nervous system fluid shunt and components Regulatory Class: Class II Product Code: JXG Dated: May 9, 2011 Received: May 10, 2011

Dear Ms. Millisky:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

{7}------------------------------------------------

Page 2 - Ms. Donna Millisky

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Melvin R. Feldmann, M.D.

Malvina B. Eydelman, M.D Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{8}------------------------------------------------

510(k) Number: KIOl38)

Device Name: Horizontal-Vertical Lumbar Valve Systems

Indications for Use:

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter-Use (Part 21 CFR 801 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 Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number K10138/

{9}------------------------------------------------

INDICATIONS FOR USE STATEMENT

510(k) Number: K10/38

Device Name: Spetzler" Lumbar Peritoneal Shunt Systems

Indications for Use:

Percutaneous lumbar peritoneal shunting may be utilized in the treatment of communicating hydrocephalus. It is designed to shunt CSF from the lumbar subarachnoid space to the peritoneal cavity.

The shunt may be used for diagnosis, evaluation or treatment of normal pressure communicating hydrocephalus.

Prescription Use × (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter-Use (Part 21 CFR 801 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 Ophthalmic, Neurological and Ear,
Nose and Throat Devices

510(k) Number K101381

Regulation Number and Section

§ 882.5550 Central nervous system fluid shunt and components.

(a)
Identification. A central nervous system fluid shunt is a device or combination of devices used to divert fluid from the brain or other part of the central nervous system to an internal delivery site or an external receptacle for the purpose of relieving elevated intracranial pressure or fluid volume (e.g., due to hydrocephalus). Components of a central nervous system shunt include catheters, valved catheters, valves, connectors, and other accessory components intended to facilitate use of the shunt or evaluation of a patient with a shunt.(b)
Classification. Class II (performance standards).