K Number
K110367
Device Name
PIONEER SPINAL PROCESS FUSION PLATE
Date Cleared
2011-03-23

(43 days)

Product Code
Regulation Number
888.3050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Pioneer BacFuse Device is a posterior, non-pedicle supplemental fixation device, intended for use at a single level in the non-cervical spine (T1-S1). It is intended for plate fixation/attachment to spinous processes for the purpose of achieving supplemental fusion in the following conditions: degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); spondylolisthesis; trauma (i.e., fracture or dislocation); and/or tumor. The Pioneer BacFuse Device is intended for use with bone graft material (i.e. allograft or autograft), not intended for stand-alone use.
Device Description
The Pioneer Spinous Process Fusion Plate is a plate with spacer system designed to provide posterior fixation by physically linking adjacent spinous processes. The system also contains Class 1 manual surgical instruments and cases that are considered exempt from premarket notification. The Pioneer Spinous Process Fusion Plate is composed of Ti Alloy per ASTM F136.
More Information

Not Found

No
The summary describes a mechanical implant and surgical instruments, with no mention of AI/ML terms or functionalities.

Yes
The device is intended for the purpose of achieving supplemental fusion in various conditions of the spine, such as degenerative disc disease, spondylolisthesis, trauma, and tumor, which are therapeutic medical purposes.

No
The device description and intended use indicate it is an implantable fixation device used to aid in spinal fusion, not to diagnose medical conditions.

No

The device description explicitly states it is a plate with spacer system composed of Ti Alloy and includes manual surgical instruments and cases, indicating it is a physical medical device, not software-only.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, or tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Description and Intended Use: The provided text clearly describes a surgical implant (a plate and spacer system) intended for posterior fixation and supplemental fusion in the spine. It is a physical device implanted in the body during surgery.
  • Lack of Specimen Analysis: There is no mention of this device being used to analyze any biological specimens. Its function is mechanical support and stabilization.

Therefore, based on the provided information, the Pioneer BacFuse Device is a surgical implant, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Pioneer BacFuse Device is a posterior, non-pedicle supplemental fixation device, intended for use at a single level in the non-cervical spine (T1-S1). It is intended for plate fixation/attachment to spinous processes for the purpose of achieving supplemental fusion in the following conditions: degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); spondylolisthesis; trauma (i.e., fracture or dislocation); and/or tumor. The Pioneer BacFuse Device is intended for use with bone graft material (i.e. allograft or autograft), not intended for stand-alone use.

Product codes

KWP

Device Description

The Pioneer Spinous Process Fusion Plate is a plate with spacer system designed to provide posterior fixation by physically linking adjacent spinous processes. The system also contains Class 1 manual surgical instruments and cases that are considered exempt from premarket notification. The Pioneer Spinous Process Fusion Plate is composed of Ti Alloy per ASTM F136.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

non-cervical spine (T1-S1), spinous processes

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)

Static torsion, static tension, static compression, static locking mechanism, dynamic flexion-extension, and dynamic locking mechanism testing was performed on the representative worst case construct for each test mode. Results found the subject device to perform equivalent or superior to predicate devices.

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

Not Found

Predicate Device(s)

K101525

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3050 Spinal interlaminal fixation orthosis.

(a)
Identification. A spinal interlaminal fixation orthosis is a device intended to be implanted made of an alloy, such as stainless steel, that consists of various hooks and a posteriorly placed compression or distraction rod. The device is implanted, usually across three adjacent vertebrae, to straighten and immobilize the spine to allow bone grafts to unite and fuse the vertebrae together. The device is used primarily in the treatment of scoliosis (a lateral curvature of the spine), but it also may be used in the treatment of fracture or dislocation of the spine, grades 3 and 4 of spondylolisthesis (a dislocation of the spinal column), and lower back syndrome.(b)
Classification. Class II.

0

MAR 2 3 2011

510(k) SUMMARY

t

Pioneer Spinous Process Fusion Plate

| Sponsor: | Manufacturer | Pioneer Surgical Technology
375 River Park Circle
Marquette, MI 49855 |
|-----------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------|
| | Official Contact | Emily M. Downs |
| | Phone: | (906) 225-5602 |
| | Fax: | (906) 226-4459 |
| | Date prepared: | February 4, 2011 |
| Device Name: | Pioneer BacFuse Spinous Process Fusion Plate | |
| Product Code/
Classification: | KWP/ 888.3050 – Spinal Interlaminal Fixation Orthosis | |
| Predicate Device:
Description: | Pioneer Spinous Process Fusion Plate (K101525, SE date 10/22/2010)
The Pioneer Spinous Process Fusion Plate is a plate with spacer system designed to
provide posterior fixation by physically linking adjacent spinous processes. | |
| | The system also contains Class 1 manual surgical instruments and cases that are
considered exempt from premarket notification. | |
| Intended Use: | The Pioneer BacFuse Device is a posterior, non-pedicle supplemental fixation
device, intended for use at a single level in the non-cervical spine (T1-S1). It is
intended for plate fixation/attachment to spinous processes for the purpose of
achieving supplemental fusion in the following conditions: degenerative disc
disease (defined as back pain of discogenic origin with degeneration of the disc
confirmed by history and radiographic studies); spondylolisthesis; trauma (i.e.,
fracture or dislocation); and/or tumor. The Pioneer BacFuse Device is intended for
use with bone graft material (i.e. allograft or autograft), not intended for stand-
alone use. | |
| Material: | The Pioneer Spinous Process Fusion Plate is composed of Ti Alloy per ASTM F136. | The predicate device is composed of the same material. |
| Performance
Data: | Static torsion, static tension, static compression, static locking mechanism, dynamic
flexion-extension, and dynamic locking mechanism testing was performed on the
representative worst case construct for each test mode. Results found the subject
device to perform equivalent or superior to predicate devices. | |

1

The indications for use of the Pioneer Spinous Process Fusion Plate are the same as Comparison to the predicate device. Implant material, design characteristics, and mechanism of Predicate action for the Pioneer Spinous Process Fusion plate are identical to that of Devices: predicate systems.

SE Determination: Equivalence for Pioneer Spinous Process Fusion System is based on similarities of intended use, design, and physical characteristics when compared to predicate devices. Therefore, Pioneer Surgical Technology believes that there is sufficient evidence to conclude that the Pioneer Spinous Process Fusion Plate System is substantially equivalent to existing legally marketed devices.

2

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room W-O66-0609 Silver Spring, MD 20993-0002

Pioneer Surgical Technology, Inc. % Ms. Emily M. Downs Regulatory Affairs Manager 375 River Park Circle Marquette, Michigan 49855

MAR 2 3 2011

Re: K110367

Trade/Device Name: Pioneer Spinous Process Fusion Plate Regulation Number: 21 CFR 888.3050 Regulation Name: Spinal interlaminal fixation orthosis Regulatory Class: II Product Code: KWP Dated: March 10, 2011 Received: March 11, 2011

Dear Ms. Downs:

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

3

Page 2 - Ms. Emily M. Downs

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/ycm1 1 5809.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/ReportalProblem/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,

Aty B. R. for

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

Enclosure

4

Indications for Use Statement

K11 0367 510(k) Number (if known):

Device Name:

Pioneer Spinous Process Fusion Plate

Indications:

The Pioneer BacFuse Device is a posterior, non-pedicle supplemental fixation device, intended for use at a single level in the non-cervical spine (T1-S1). It is intended for plate fixation/attachment to spinous processes for the purpose of achieving supplemental fusion in the following conditions: degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); spondylolisthesis; trauma (i.e., fracture or dislocation); and/or tumor. The Pioneer BacFuse Device is intended for use with bone graft material (i.e. allograft or autograft), not intended for stand-alone use.

Prescription Use _ V

Over-the-Counter Use

(Per 21 CFR 801.109)

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

OR

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)

Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number_________________________________________________________________________________________________________________________________________________________________