K Number
K110140
Device Name
NEUROVISION NERVE LOCATOR MONITOR
Date Cleared
2011-09-30

(255 days)

Product Code
Regulation Number
882.1870
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Neurovision Nerve Locator Monitor is an electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor with integrated detecting or warning capability. The device is intended to assist the surgeon in locating motor nerves that are at risk in surgical procedures.
Device Description
The Neurovision Nerve Locator Monitor Model NV006 is a single channel evoked EMG device for surgical nerve location and monitoring. The device operates exactly as the predicate model NV004. The stimulation range for the predicate device (Model NV004) as a proactive nerve locator is up to 5.0 mA of pulsed nerve stimulation. An accessory cable adds optional "high level" stimulation (Model NV006) ranging from 3.0 to 12 mA.
More Information

Not Found

No
The summary describes a device that uses electrical stimulation and EMG monitoring to locate nerves, with no mention of AI or ML technologies.

No
The device is intended to assist surgeons in locating motor nerves and monitoring EMG, which is a diagnostic and monitoring function, not a therapeutic one. It does not treat or cure a condition.

Yes

The device is intended to assist the surgeon in locating motor nerves and provides evoked EMG monitoring, which is a diagnostic function to inform surgical decisions.

No

The device description explicitly states it is an "electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor," and mentions "pulsed nerve stimulation" and "accessory cable," all of which indicate hardware components are integral to the device's function.

Based on the provided information, the Neurovision Nerve Locator Monitor 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. They are used to provide information for diagnosis, monitoring, or screening.
  • Neurovision Nerve Locator Monitor Function: The description clearly states the device is an electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor. Its intended use is to assist the surgeon in locating motor nerves during surgical procedures. It works by stimulating nerves and monitoring the resulting muscle activity (EMG).
  • No Sample Analysis: The device does not analyze any samples taken from the body. It interacts directly with the patient's nerves and muscles during surgery.

Therefore, the Neurovision Nerve Locator Monitor falls under the category of a surgical device or neuromonitoring device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Neurovision Nerve Locator Monitor is an electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor with integrated detecting or warning capability. The device is intended to assist the surgeon in locating motor nerves that are at risk in surgical procedures.

Product codes

GWF, ETN

Device Description

The Neurovision Nerve Locator Monitor Model NV006 is a single channel evoked EMG device for surgical nerve location and monitoring. The device operates exactly as the predicate model NV004. The stimulation range for the predicate device (Model NV004) as a proactive nerve locator is up to 5.0 mA of pulsed nerve stimulation. An accessory cable adds optional "high level" stimulation (Model NV006) ranging from 3.0 to 12 mA.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

motor nerves

Indicated Patient Age Range

Not Found

Intended User / Care Setting

surgeon, qualified, trained medical practioners who perform operative surgery

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

Preclinical testing verified the design of this device and that all specified requirements were fulfilled.

Key Metrics

Not Found

Predicate Device(s)

K954601, K002677

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 882.1870 Evoked response electrical stimulator.

(a)
Identification. An evoked response electrical stimulator is a device used to apply an electrical stimulus to a patient by means of skin electrodes for the purpose of measuring the evoked response.(b)
Classification. Class II (performance standards).

0

K110140

Image /page/0/Picture/1 description: The image shows the logo for Neurovision Medical. The word "neurovision" is written in bold, black letters on the top line. Below that, there is a black line with a heartbeat symbol in the middle, and the word "MEDICAL" is written in bold, black letters to the right of the heartbeat symbol.

30
2011

Traditional 510k - Neurovision Nerve Locator/Monitor Model NV006

510K Summary

In accordance with Title 21 of the Code of Federal Regulations, Part 807 and in particular 21 CFR §807.92, the following summary of information is provided:

Applicant Information

Christine Vergely Regulatory Affairs Manager Neurovision Medical Products, Inc. 2225 Sperry Ave., Suite 1000 Ventura, CA 93003 Ph 805-866-6999 Fax: 413-410-4579 christie@neurovisionmedical.com

Date of Summary: 5/02/11

Device Identification:

Trade Name: Neurovision Nerve Locator Monitor NV006 (tbd) Common Name: Nerve Monitor/Locator System Regulation Number: 21 CFR 882.1870 Regulation Name: Evoked Response Electrical Stimulator Regulatory Class: Class II Product Code: GWF, ETN

Predicate Devices

Neurovision, Nerve Locator/Monitor System Modification NV004 model (K954601) NuVasive, INS-1 Intraoperative Nerve Surveillance System (K002677)

Device Description

The Neurovision Nerve Locator Monitor Model NV006 is a single channel evoked EMG device for surgical nerve location and monitoring. The device operates exactly as the predicate model NV004. The stimulation range for the predicate device (Model NV004) as a proactive nerve locator is up to 5.0 mA of pulsed nerve stimulation. An accessory cable adds optional "high level" stimulation (Model NV006) ranging from 3.0 to 12 mA.

Intended Use

The Neurovision Nerve Locator Monitor is an electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor with integrated detecting or warning capability. The device is intended to assist the surgeon in locating motor nerves that are at risk in surgical procedures.

Technological Characteristics of Device in Relation to Predicate Devices

The Neurovision High-Stim Nerve Locator/Monitor modification uses a dedicated stimulation cable assembly, the CSTI-HS, to activate an embedded capability to deliver nerve stimulation at higher levels (to 12 mA pulsed stimulation) as sometimes required for spinal screw testing purposes. The "HighStim" Cable Assembly, which activates higher level stimulation, is provided to the user as an accessory with the NV006 model in addition to the standard Stimulating Cable Assembly (CSTI).

P. 1 of 4

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Image /page/1/Picture/0 description: The image shows the logo for Neurovision Medical. The word "neurovision" is in large, bold, sans-serif font. Below the word "neurovision" is a horizontal line with a small upward spike in the middle. To the right of the line is the word "MEDICAL" in a smaller, sans-serif font.

Traditional 510k – Neurovision Nerve Locator/Monitor Model NV006

Table 1: NV004 to NV006 Modification Comparison
FeatureNV004 (K954601)NV006 (High-Stim version)
Indications for UsePer 510(k)Same plus addition of spinal
procedures
Digital DisplayN/AProvides electrode
impedance readings
FirmwareAssembly LanguageSame
Logical AlgorithmNeurovision proactive nerve
location algorithmSame
Stim voltage limit38 vSame
Stimulation outputMax 5mA, 5 steps, constant
currentMax 5mA/12 mA, 10 steps,
high range by separate cable.
Lowest setting 0.1mA
conforms to ISO 60601-2-40
Stim delivered audio"Tic-tic" audio alertSame
Stimulation calibrationNoneAccurate within 5% of
delivered current
EMGVariable gainSame
ChannelsOneSame
Electrode off4 beep alarmSame
Impedance measure>15 k fixed alertActual measurement with
digital display
Audio outSounderSpeaker
Audio modeFixed alarms onlyAlarms only, raw EMG only,
or both, user select
Audio alarm toneBeepSame
VolumeVariable, no zeroSame
Self-test featureAnalog CAP internalSame
Event LEDPresentSame
Battery LEDPresentSame
Data outAnalog raw EMG outSerial USB out; raw EMG and
status data
Data collectionDigital PC oscilloscopeDedicated digital EMGView
oscilloscope software
(K102861)
Cable AssemblyEMG and Stimulation (low)Same plus additional High-
Stimulation cable
Stimulating Lead WireReusable / user sterilizable
wire, disposable sterileDisposable sterile wire
CircuitryAnalog/digitalSame
LayoutThru-hole componentsSame plus surface mount
IsolationPer designImproved physical isolation;
shielding by Opto Isolators
High Stim LEDN/AActivated when High Stim
cable in use
Power20 v AC Power
Supply/Charger; not
certified12 V DC Power
Supply/Charger; certified
Nerve Location IndicationDetection circuitry always
activeDetection circuitry active only
during stimulation. Helps
prevent false alarms
Laryngeal Surface electrode-
accessoryAccessory sold separatelyCleared through K003745
Stimulating Hemostat-
accessoryAccessory included with
SystemCleared through K895676
Hydrogel Ground-accessoryAccessory sold separatelyCleared through K092744
and K110138
Needle Ground Electrode -
accessoryAccessory sold separatelyCleared through K091056

. .

110140 p.2 of 4

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Image /page/2/Picture/0 description: The image shows the logo for Neurovision Medical. The word "neurovision" is in large, bold, black letters. Underneath the word "neurovision" is a black line with a heartbeat symbol in the middle, followed by the word "MEDICAL" in bold, black letters.

Traditional 510k – Neurovision Nerve Locator/Monitor Model NV006

Table 2: Substantial Equivalence Comparison
PredicateSubject Device
FeatureNeurovision Nerve
Locator/Monitor
System Modification
NV004 (K954601)NuVasive INS-1
(K002677)Neurovision Nerve
Locator Monitor
Model NV006
DescriptionEvoked EMG nerve
locator/monitorEvoked EMG nerve
locator/monitorEvoked EMG nerve
locator/monitor
Intended UseThe Neurovision Nerve
Locator/Monitor is an
electronic device
consisting of a surgical
nerve stimulator and an
evoked EMG monitor
with integrated detecting
and warning
capability. This device is
intended for use in
surgical procedures
where motor nerves areThe INS-1 Intraoperative
Nerve Surveillance
System is intended to
provide intraoperative
electromyographic
(EMG) surveillance to
assist in the location and
evaluation of spinal
nerves during
percutaneous surgery of
the spine, byThe Neurovision
Nerve Locator
Monitor is an
electronic device
consisting of a
surgical nerve
stimulator and an
evoked EMG Monitor
with integrated
detecting or warning

110140 P-3 of 4

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Image /page/3/Picture/0 description: The image shows the logo for Neurovision Medical. The word "neurovision" is in bold, black letters on the top line. Underneath, there are two horizontal lines with a small, jagged line in the middle, followed by the word "MEDICAL" in bold, black letters.

Traditional 510k – Neurovision Nerve Locator/Monitor Model NV006

| | at risk to assist the
surgeon in locating
these nerves. This
device is intended for
use only by qualified,
trained medical
practioners who perform
operative surgery and
fully understand that this
device is only and
adjuvant to proper
surgical technique and
good surgical judgment. | administration of low
amperage electrical
energy to tissues and
nerves at the operative
site, and EMG monitoring
of muscle groups
associated with those
nerves. The INS-1
System is designed for
use in conjunction with
the Nuvasive Guided
Spinal Arthroscopy
System to assist in
gaining controlled
percutaneous access to
the spinal nerve root,
foramina, intervertebral
disk, and surrounding
tissues of the spine via
uniportal or biportal
posterior or
posterolateral approach,
where anatomical
restrictions safely permit. | capability. The
device is intended to
assist the surgeon in
locating motor nerves
that are at risk in
surgical procedures. |
|--------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------|
| Stimulation
Intensity | 150 microsecond
square pulse, 4 per
second, (0.1-5.0 mA, 10
steps); Maximum 42
VDC, 5 mA | 200 microsecond square
pulse, 4 per second,
0.4mA -12mA, Maximum
240 VDC | 150 microsecond
square pulse, 4 per
second, 0.1-5.0 mA
(Low) and 3.0-12 mA
(High) 10 steps;
Maximum 42 VDC,
12 mA |

Performance Testing

Preclinical testing verified the design of this device and that all specified requirements were fulfilled

110140 p.48/4

4

Image /page/4/Picture/1 description: The image shows a logo for the Department of Health & Human Services. The logo features a stylized abstract symbol resembling an eagle or bird in flight, composed of three curved lines. The text "DEPARTMENT OF HEALTH &" is vertically oriented along the left side of the logo, with "HUMAN SERVICES" appearing below it.

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

Neurovision Medical Products, Inc. c/o Ms. Christine Vergely Regulatory Manager 2225 Sperry Avenue, Suite 1000 Ventura, CA 93003

SEP 3 0 2011

Re: K110140

Trade/Device Name: Nerve Locator Monitor (NV006) Regulation Number: 21 CFR 882.1870 Regulation Name: Evoked Response Electrical Stimulator Regulatory Class: Class II Product Code: GWF, ETN Dated: September 20, 2011 Received: September 22, 2011

Dear Ms. Vergely:

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, forug 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/jability 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

5

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.html 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 yours,
Debra Falls

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

6

Indications for Use

510(k) Number (if known): K110140

Device Name: Neurovision Nerve Locator/Monitor Model NV006

Indications for Use:

The Neurovision Nerve Locator Monitor is an electronic device consisting of a surgical nerve stimulator and an evoked EMG Monitor with integrated detecting or warning capability. The device is intended to assist the surgeon in locating motor nerves that are at risk in surgical procedures.

Prescription Use _ X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

| Prescription Use.

(Per 21 CFR 801.109)
------------------------------------------------------------------------------------------------------------------------------------------------------------------

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off)

Division of Ophthalmic, Neurological and Ear,
Nose and Throat Devices

510(k) NumberK110140
------------------------

510(k) Number_