K Number
K103147
Device Name
NOVEL III SPINAL FIXATION AND ADJUSTABLE BRIDGE SYSTEM
Manufacturer
Date Cleared
2010-12-16

(52 days)

Product Code
Regulation Number
888.3070
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Novel III Spinal System is a pedicle screw system indicated for the treatment of severe Spondylolisthesis (Grade 3 and 4) of the L5-S 1 vertebra in skeletally mature patients receiving fusion by autogenous bone graft having implants attached to the lumbar and sacral spine (L3 to sacrum) with removal of the implants after the attainment of a solid fusion. In addition, the Novel Spinal System is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic lumbar and sacral spine: degenerative Spondylolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor and failed previous fusion (pseudarthrosis).
Device Description
The Novel ///™ Spinal Fixation and Adjustable Bridge System is a top-loading posterior spinal fixation system which consists of pedicle screws, rods, set screws, and a transverse (cross) linking mechanism. The Novel III TM Spinal Fixation and Adjustable Bridge System implant components are fabricated from titanium alloy (Ti-6AI-4V ELI) that conforms to ASTM F 136. Various sizes of these implants are available. Specialized instruments made from surgical instrument grade stainless steel are available for the application and removal of the Novel ///™ Spinal Fixation and Adjustable Bridge System implants.
More Information

Not Found

No
The summary describes a mechanical spinal fixation system and its components. There is no mention of software, algorithms, image processing, AI, or ML.

Yes
The device is a pedicle screw system explicitly indicated for the treatment of severe Spondylolisthesis and various spinal instabilities or deformities, which are medical conditions, and thus its purpose is therapeutic by providing stabilization and immobilization to anatomical structures.

No

The provided text describes a pedicle screw system used for surgical implantation to treat spinal instabilities and deformities. It is a therapeutic device intended to provide stabilization and immobilization, not to diagnose conditions.

No

The device description explicitly states it consists of physical components like pedicle screws, rods, set screws, and a transverse linking mechanism, all fabricated from titanium alloy. This indicates a hardware-based medical device, not a software-only one.

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

Here's why:

  • Intended Use: The intended use clearly describes a surgical implant system used to stabilize and fuse segments of the spine. This is a therapeutic device, not a diagnostic one.
  • Device Description: The description details physical components like pedicle screws, rods, and set screws, all of which are used in surgical procedures.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or providing information for diagnosis.
  • Performance Studies: The performance studies focus on mechanical testing of the device's strength and durability, which is relevant for a surgical implant, not an IVD.

IVD devices are used to examine specimens derived from the human body to provide information for the diagnosis, prevention, or treatment of a disease or condition. This device does not fit that description.

N/A

Intended Use / Indications for Use

The Novel III Spinal System is a pedicle screw system indicated for the treatment of severe Spondylolisthesis (Grade 3 and 4) of the L5-S 1 vertebra in skeletally mature patients receiving fusion by autogenous bone graft having implants attached to the lumbar and sacral spine (L3 to sacrum) with removal of the implants after the attainment of a solid fusion. In addition, the Novel Spinal System is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic lumbar and sacral spine: degenerative Spondylolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor and failed previous fusion (pseudarthrosis).

Product codes

MNI, MNH, KWQ

Device Description

The Novel ///™ Spinal Fixation and Adjustable Bridge System is a top-loading posterior spinal fixation system which consists of pedicle screws, rods, set screws, and a transverse (cross) linking mechanism. The Novel III TM Spinal Fixation and Adjustable Bridge System implant components are fabricated from titanium alloy (Ti-6AI-4V ELI) that conforms to ASTM F 136. Various sizes of these implants are available.
Specialized instruments made from surgical instrument grade stainless steel are available for the application and removal of the Novel ///™ Spinal Fixation and Adjustable Bridge System implants.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

L5-S 1 vertebra, lumbar and sacral spine (L3 to sacrum), thoracic lumbar and sacral spine

Indicated Patient Age Range

skeletally mature patients

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)

The predicate device underwent mechanical testing included Static Compression Bending; Static Tension Bending; Static Torsional; also Dynamic Compression Fatigue Testing. All testing performed per ASTM F 1717-04. The subject device contains dimensionally modified components (not worst case) and therefore not subject to ASTM F 1717-04 additional testing.

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

Not Found

Predicate Device(s)

K081153

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3070 Thoracolumbosacral pedicle screw system.

(a)
Identification. (1) Rigid pedicle screw systems are comprised of multiple components, made from a variety of materials that allow the surgeon to build an implant system to fit the patient's anatomical and physiological requirements. Such a spinal implant assembly consists of a combination of screws, longitudinal members (e.g., plates, rods including dual diameter rods, plate/rod combinations), transverse or cross connectors, and interconnection mechanisms (e.g., rod-to-rod connectors, offset connectors).(2) Semi-rigid systems are defined as systems that contain one or more of the following features (including but not limited to): Non-uniform longitudinal elements, or features that allow more motion or flexibility compared to rigid systems.
(b)
Classification. (1) Class II (special controls), when intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine: severe spondylolisthesis (grades 3 and 4) of the L5-S1 vertebra; degenerative spondylolisthesis with objective evidence of neurologic impairment; fracture; dislocation; scoliosis; kyphosis; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply with the following special controls:(i) Compliance with material standards;
(ii) Compliance with mechanical testing standards;
(iii) Compliance with biocompatibility standards; and
(iv) Labeling that contains these two statements in addition to other appropriate labeling information:
“Warning: The safety and effectiveness of pedicle screw spinal systems have been established only for spinal conditions with significant mechanical instability or deformity requiring fusion with instrumentation. These conditions are significant mechanical instability or deformity of the thoracic, lumbar, and sacral spine secondary to severe spondylolisthesis (grades 3 and 4) of the L5-S1 vertebra, degenerative spondylolisthesis with objective evidence of neurologic impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor, and failed previous fusion (pseudarthrosis). The safety and effectiveness of these devices for any other conditions are unknown.”
“Precaution: The implantation of pedicle screw spinal systems should be performed only by experienced spinal surgeons with specific training in the use of this pedicle screw spinal system because this is a technically demanding procedure presenting a risk of serious injury to the patient.”
(2) Class II (special controls), when a rigid pedicle screw system is intended to provide immobilization and stabilization of spinal segments in the thoracic, lumbar, and sacral spine as an adjunct to fusion in the treatment of degenerative disc disease and spondylolisthesis other than either severe spondylolisthesis (grades 3 and 4) at L5-S1 or degenerative spondylolisthesis with objective evidence of neurologic impairment. These pedicle screw systems must comply with the following special controls:
(i) The design characteristics of the device, including engineering schematics, must ensure that the geometry and material composition are consistent with the intended use.
(ii) Non-clinical performance testing must demonstrate the mechanical function and durability of the implant.
(iii) Device components must be demonstrated to be biocompatible.
(iv) Validation testing must demonstrate the cleanliness and sterility of, or the ability to clean and sterilize, the device components and device-specific instruments.
(v) Labeling must include the following:
(A) A clear description of the technological features of the device including identification of device materials and the principles of device operation;
(B) Intended use and indications for use, including levels of fixation;
(C) Identification of magnetic resonance (MR) compatibility status;
(D) Cleaning and sterilization instructions for devices and instruments that are provided non-sterile to the end user; and
(E) Detailed instructions of each surgical step, including device removal.
(3) Class II (special controls), when a semi-rigid system is intended to provide immobilization and stabilization of spinal segments in the thoracic, lumbar, and sacral spine as an adjunct to fusion for any indication. In addition to complying with the special controls in paragraphs (b)(2)(i) through (v) of this section, these pedicle screw systems must comply with the following special controls:
(i) Demonstration that clinical performance characteristics of the device support the intended use of the product, including assessment of fusion compared to a clinically acceptable fusion rate.
(ii) Semi-rigid systems marketed prior to the effective date of this reclassification must submit an amendment to their previously cleared premarket notification (510(k)) demonstrating compliance with the special controls in paragraphs (b)(2)(i) through (v) and paragraph (b)(3)(i) of this section.

0

K103147

510(k) SUMMARY

DEC 1 6 2010

!

"Special 510 (K): Device Modification" Premarket Notification: Novel III™ Spinal Fixation and Adjustable Bridge System

1. Submitter/Sponsor:

Medvssev Co. Ltd. Patrick D. Moore, Official US Correspondent 722-3, 4F. Science Tower, Jihaeng-dong, Dongducheon-city, Gyeonggi-do, Korea

Contact person:

Patrick D. Moore Official US Correspondent Medyssey Co. Ltd. 6170 South 380 West, Suite 200. Murray, Utah. 84107 801-266-4811, Fax. 801-266-4363; E-Mail: pdmoore@jemospine.com Tel.

Date Prepared:

October 20, 2010

2. Device Name:

Classification Name:Pedicle Screw Spinal Fixation System
Common/Generic Name:Pedicle Screw Spinal System
Trade Name:Novel III ™ Spinal Fixation and Adjustable Bridge System

3. Device Classification(s):

Class II (88.3390) following Orthopedic and Rehabilitation Device Advisory Review, for the requested indications:

  • Spinal Pedicle Screw (MNI) 21 CFR § 888.3070 .
  • Spondylolisthesis Spinal Fixation Device System (MNH) 21 CFR § . 888.3070
  • Spinal Intervertebral Body Fixation Orthosis (KWQ) 21 CFR § 888.3060 .

4. Predicate Device:

Medyssey Co., Ltd., Novel™ Spinal System - MNI, MNH, KWQ -- (K081153)

5. Device Description:

The Novel ///™ Spinal Fixation and Adjustable Bridge System is a top-loading posterior spinal fixation system which consists of pedicle screws, rods, set screws, and a transverse (cross) linking mechanism. The Novel III TM Spinal Fixation and Adjustable Bridge System implant components are fabricated from titanium alloy (Ti-6AI-4V ELI) that conforms to ASTM F 136. Various sizes of these implants are available.

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E. Page 24

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K10 3147

Specialized instruments made from surgical instrument grade stainless steel are available for the application and removal of the Novel ///™ Spinal Fixation and Adjustable Bridge System implants.

6. Intended Use:

The Novel III Spinal System is a pedicle screw system indicated for the treatment of severe Spondvlolisthesis (Grade 3 and 4) of the L5-S 1 vertebra in skeletally mature patients receiving fusion by autogenous bone graft having implants attached to the lumbar and sacral spine (L3 to sacrum) with removal of the implants after the attainment of a solid fusion.

In addition. the Novel Spinal System is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic lumbar and sacral spine: degenerative Spondvlolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor and failed previous fusion (pseudarthrosis).

  1. Comparison with predicate device: The Novel ///™ Spinal System is substantially equivalent to the currently marketed Novel™ Spinal System. When considered for anterior applications, both the Novel ///TM Spinal Fixation and Adjustable Bridge System and the Nove/™ Spinal System worst case constructs consist of the same universal housing containing the same pre-assembled pedicle screw and set screw. Both systems use the same vertical rods which are both placed into the housing. The same set screws are subsequently tightened onto the rod. providing a completed implant assembly.

The principles of operation for the subject Novel ///™ Spinal Fixation and Adjustable Bridge System device, and the cited predicate technologies are same. That is, each of these products employs the same indications for use, contraindications for use, warnings and precautions within labeling. The principles of operation of the subject device are directly equivalent to those of the cited predicates cleared by the Agency and currently being marketed.

The design and development process of the manufacturer of subject system and Predicate system conforms to 21 CFR part 820, ISO 9001 and ISO 13485 quality systems.

The subject and predicate device was evaluated/tested per established requirements. . .

The predicate device underwent mechanical testing included Static Compression Bending; Static Tension Bending; Static Torsional; also Dynamic Compression Fatigue Testing. All testing performed per ASTM F 1717-04. The subject device contains dimensionally modified components (not worst case) and therefore not subject to ASTM F 1717-04 additional testing.

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Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a stylized eagle with three lines forming its body and wings. The eagle is positioned within a circular border that contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" in a circular arrangement.

Food and Drug Administration 1 (0903 New Hampshire Avenue Document Control Room -- WO66-G609 Silver Spring. MD 20993-0002

Medyssev Co. Ltd. % Mr. Patrick Moore Official US Correspondent 6170 South 380 West, Suite 200 Murray, Utah 84107

DEC 16 2010

Re: K103147

Trade/Device Name: Novel III™ Spinal Fixation and Adjustable Bridge System Regulation Number: 21 CFR 888.3070 Regulation Name: Pedicle screw spinal system Regulatory Class: Class II Product Code: MNI, MNH, KWQ Dated: November 30, 2010 Received: December 2, 2010

Dear Mr. Moore:

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.

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

3

Page 2 - Mr. Patrick Moore

forth in the quality systems (OS) 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/CDRH0ffices/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/Resourcesfor You/Industry/default.htm.

Sincerely vours.

Mule A. Mckenn

Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

K103147

510(k) Number (original): Koor 153 "Special 510(k). Device Modification" Number (if known):

DEC 1 6 2010

Device Name: Novel III™ Spinal Fixation and Adiustable Bridge System

Indications for Use: The Novel III Spinal System is a pedicle screw system indicated for the treatment of severe Spondylolisthesis (Grade 3 and 4) of the L5-$ 1 vertebra in skeletally mature patients receiving fusion by autogenous bone graft having implants attached to the lumbar and sacral spine (L3 to sacrum) with removal of the implants after the attainment of a solid fusion. In addition, the Novel Spinal System is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic lumbar and sacral spine: degenerative Spondylolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor and failed previous fusion (pseudarthrosis).

Prescription Use______________________________________________________________________________________________________________________________________________________________ X (Per 21 CFR 801.109) (Optional Format 1-2-96)

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

Concurrence of CDRH. Office of Device Evaluation (ODE)

Mark A. Millkum

(Division Sign-Off) (Division Sign-Off)
Division of Surgical, Orthopedic,
Division of Surgical, Devices Division of Surgh
and Restorative Devices and Restorative Devices

K103147

510(k) Number _

P. L.L