K Number
K110512
Device Name
SIMMETRY SACROILIAC JOINT FUSION SYSTEM
Date Cleared
2011-03-23

(28 days)

Product Code
Regulation Number
888.3040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The SImmetry™ Sacroiliac Joint Fusion System is intended for fixation of large bones, including bones of the pelvis, for conditions including degenerative sacroiliitis and sacroiliac joint disruptions.
Device Description
The SImmetryTM Sacroiliac Joint Fusion System consists of cannulated screws available in titanium having diameters ranging from 6.5mm-12.5mm; and lengths of 30mm-70mm; titanium washers are available for the 6.5mm diameter screws. The revised surgical technique manual for the new modified version of the SImmetry™ Sacroiliac Joint Fusion System contain instructions for adding autologous graft material to the sacroiliac joint to help ensure fusion.
More Information

No
The summary describes a mechanical device (screws and washers) for bone fixation and mentions a surgical technique modification involving autologous graft material. There is no mention of AI, ML, image processing, or any software-driven analytical capabilities.

Yes
The device is intended for fixation of large bones for conditions including degenerative sacroiliitis and sacroiliac joint disruptions, aligning with the definition of a therapeutic device.

No
The device, the SImmetry™ Sacroiliac Joint Fusion System, is intended for fixation of large bones and fusion of the sacroiliac joint, indicating it is a therapeutic or surgical device, not a diagnostic one.

No

The device description explicitly states it consists of cannulated screws and washers, which are hardware components.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health.
  • Device Description: The SImmetry™ Sacroiliac Joint Fusion System is a system of screws and washers intended for surgical fixation of bones. It is a physical implant used within the body, not a device used to test samples outside the body.
  • Intended Use: The intended use is for "fixation of large bones... for conditions including degenerative sacroiliitis and sacroiliac joint disruptions." This describes a surgical procedure, not a diagnostic test.

Therefore, based on the provided information, the SImmetry™ Sacroiliac Joint Fusion System is a surgical implant, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The SImmetry™ Sacroiliac Joint Fusion System is intended for fixation of large bones, including bones of the pelvis, for conditions including degenerative sacroiliitis and sacroiliac joint disruptions.

Product codes

OUR

Device Description

The SImmetryTM Sacroiliac Joint Fusion System consists of cannulated screws available in titanium having diameters ranging from 6.5mm-12.5mm; and lengths of 30mm-70mm; titanium washers are available for the 6.5mm diameter screws. The revised surgical technique manual for the new modified version of the SImmetry™ Sacroiliac Joint Fusion System contain instructions for adding autologous graft material to the sacroiliac joint to help ensure fusion.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

bones of the pelvis

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)

The modification from the previous version of this device does not affect the intended use or alter the fundamental scientific technology or performance of the device when compared to the identified predicate. The addition of autologous graft material to the sacroiliac joint does not require testing to ensure substantial equivalence to the unmodified device.

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

Not Found

Predicate Device(s)

K102907

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3040 Smooth or threaded metallic bone fixation fastener.

(a)
Identification. A smooth or threaded metallic bone fixation fastener is a device intended to be implanted that consists of a stiff wire segment or rod made of alloys, such as cobalt-chromium-molybdenum and stainless steel, and that may be smooth on the outside, fully or partially threaded, straight or U-shaped; and may be either blunt pointed, sharp pointed, or have a formed, slotted head on the end. It may be used for fixation of bone fractures, for bone reconstructions, as a guide pin for insertion of other implants, or it may be implanted through the skin so that a pulling force (traction) may be applied to the skeletal system.(b)
Classification. Class II.

0

K110512

Zyga Technology, Inc. Special 510(k) - SImmetry™ Sacroiliac Joint Fusion System Modification MAR 2 3 20i1 February 21, 2011

Attachment F

510(k) Summary and Certification

[As required by 21 CFR 807.92(c)]

1. Submitter / Contact Person / Date of Preparation

| Submitter | Zyga Technology, Inc.
700 10th Ave South
Minneapolis, MN 55415-1745 |
|---------------------|--------------------------------------------------------------------------------------------------------|
| Contact Person | Diane Brinza
Director of Regulatory and Clinical
Ph. 612.455.1061, ext. 104
Fax. 612.455.1064 |
| Date of Preparation | February 21, 2011 |

2. General Information

Trade NameSImmetryTM Sacroiliac Joint Fusion System
Common / Usual
NameFixation Device/Bone Screw
Classification NameSmooth or threaded metallic bone fixation fastener
ClassificationClass II (per 21 CFR § 888.3040)
ManufacturerZyga Technology, Inc.
700 10th Ave South
Minneapolis, MN 55415-1745
Identification of
Predicate DevicesK102907
Zyga Technology, Inc.
SImmetryTM Sacroiliac Joint Fusion System
Device DescriptionThe SImmetryTM Sacroiliac Joint Fusion System
consists of cannulated screws available in titanium
having diameters ranging from 6.5mm-12.5mm; and
lengths of 30mm-70mm; titanium washers are available
for the 6.5mm diameter screws. The revised surgical
technique manual for the new modified version of the
SImmetry™ Sacroiliac Joint Fusion System contain
instructions for adding autologous graft material to the
sacroiliac joint to help ensure fusion.
Intended Use /
Indications for UseThe SImmetry™ Sacroiliac Joint Fusion System is
intended for fixation of large bones, including bones of
the pelvis, for conditions including degenerative
sacroiliitis and sacroiliac joint disruptions.
Technological
CharacteristicThe principle of operation and fundamental scientific
technology of the subject devices is identical to that of
the identified predicate.
MaterialsThe subject devices are manufactured from Titanium
Alloy (Ti-6Al-4V ELI).
Technological
ComparisonThe modification of the SImmetry™ Sacroiliac Joint
Fusion System does not represent a change in
technological characteristics from that of the indicated
predicate device, and therefore does not raise any new
questions of safety or effectiveness.
Summary of
Non-clinical
Performance DataThe modification from the previous version of this
device does not affect the intended use or alter the
fundamental scientific technology or performance of
the device when compared to the identified predicate.
The addition of autologous graft material to the
sacroiliac joint does not require testing to ensure
substantial equivalence to the unmodified device.
ConclusionEquivalence for the SImmetry Sacroiliac Joint Fusion
System is based on the same indications for use, design
features, operational principles, and material
composition and mechanical performance when
compared to the predicate device cleared under
K102907.

1

Zyga Technology, Inc. Special 510(k) - SImmetry™ Sacroiliac Joint Fusion System Modification February 21, 2011 ﺳﮯ

.

2

Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract image of an eagle.

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

Zyga Technology, Inc. % Ms. Diane Brinza Director of Regulatory and Clinical 700 10th Avenue South, Suite 400 Minneapolis, Minnesota 55415

MAR 2 3 2011

Re: K110512

Trade/Device Name: SImmetry Sacroiliac Joint Fusion System Regulation Number: 21 CFR 888.3040 Regulation Name: Smooth or threaded metallic bone fixation fastener Regulatory Class: Class II Product Code: OUR Dated: February 21, 2011 Received: February 23, 2011

Dear Ms. Brinza:

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

3

Page 2 - Ms. Diane Brinza

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/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,

Ky B. n h
for

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

Enclosure

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Zyga Technology, Inc. Special 510(k) - SImmetry™ Sacroiliac Joint Fusion System Modification February 21, 2011

Attachment >

Indications for Use Statement

510(k) Number (if known)
Device NameSImmetry Sacroiliac Joint Fusion System
Indications for UseThe SImmetry™ Sacroiliac Joint Fusion System is intended for fixation of large bones, including bones of the pelvis, for conditions including degenerative sacroiliitis and sacroiliac joint disruptions.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use X (Per 21 CFR 801. 109) OR

Page 26

Over-The-Counter Use_

for M. Melleerson
(Division Sign-Off)

Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K110572