K Number
K143572
Device Name
Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK, Intersomatic Transforaminal - TLIF PEEK
Date Cleared
2015-06-10

(175 days)

Product Code
Regulation Number
888.3080
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Intersomatic Cervical Device - DICOM PEEK is intended for anterior interbody spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one disc level (C2-C3 disc to the C7-T1 disc). Cervical degenerative disc disease is defined as neck pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. This device is intended for use with additional supplemental fixation systems and autogenous bone graft implanted via an open, anterior approach. Patients should have at least six weeks of non-operative treatment prior to treatment with intervertebral cage. The Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal - TLIF PEEK is indicated for intervertebral body spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis at the involved level(s). DIMEI and TLIF Spinal Implants are to be used with autogenous bone graft and implanted via an open posterior or transforaminal approach. The DIMEI and TLIF Spinal Implant is to be used with additional supplemental fixation. Patients should have at least six (6) months of non-operative treatment prior to treatment with an intervertebral cage.
Device Description
The Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal - TLIF PEEK were developed as implants for the stabilization of the cervical and lumbar spinal column. The implants have ridges on both their inferior and superior surfaces to prevent migration, and graft windows which help facilitate bony integration. X-ray markers are integrated for visualization of the implants during and after surgery.
More Information

P980048 S3, K071724, K073351, K081968, K091088, K082310, P960025, P950019, K090707

No
The 510(k) summary describes a passive implant (interbody fusion device) and does not mention any software, algorithms, or data processing capabilities that would indicate the use of AI/ML. The performance studies are focused on mechanical properties, not algorithmic performance.

Yes
This device is an implantable medical device used for spinal fusion procedures to treat degenerative disc disease, which qualifies it as a therapeutic device.

No

These devices (Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK, and Intersomatic Transforaminal - TLIF PEEK) are described as implants for spinal fusion procedures, intended to stabilize the spinal column and facilitate bony integration. They are treatment devices for degenerative disc disease, not diagnostic tools.

No

The device description clearly states that the devices are "implants for the stabilization of the cervical and lumbar spinal column," which are physical hardware components. The performance studies also focus on mechanical testing of these physical implants.

Based on the provided information, 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 about a person's health.
  • Device Description and Intended Use: The description clearly states that this device is an implant intended for spinal fusion procedures. It is surgically placed within the body to stabilize the spine.
  • Lack of Specimen Analysis: There is no mention of the device being used to analyze any biological specimens. Its function is purely mechanical and structural within the body.

Therefore, the Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK, and Intersomatic Transforaminal - TLIF PEEK are medical devices, specifically implants, and not IVDs.

N/A

Intended Use / Indications for Use

The Intersomatic Cervical Device - DICOM PEEK is intended for anterior interbody spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one disc level (C2-C3 disc to the C7-T1 disc). Cervical degenerative disc disease is defined as neck pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. This device is intended for use with additional supplemental fixation systems and autogenous bone graft implanted via an open, anterior approach. Patients should have at least six weeks of non-operative treatment prior to treatment with intervertebral cage.

The Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal - TLIF PEEK is indicated for intervertebral body spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis at the involved level(s). DIMEI and TLIF Spinal Implants are to be used with autogenous bone graft and implanted via an open posterior or transforaminal approach. The DIMEI and TLIF Spinal Implant is to be used with additional supplemental fixation. Patients should have at least six (6) months of non-operative treatment with an intervertebral cage.

Product codes

ODP, MAX

Device Description

The Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal - TLIF PEEK were developed as implants for the stabilization of the cervical and lumbar spinal column. The implants have ridges on both their inferior and superior surfaces to prevent migration, and graft windows which help facilitate bony integration. X-ray markers are integrated for visualization of the implants during and after surgery.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cervical and lumbar spinal column

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

No clinical studies were performed. Non-clinical tests included: Static and dynamic compression per ASTM F2077; Static and dynamic torsion per ASTM F2077; Subsidence per ASTM F2267. The results of these evaluations indicate that the DICOM PEEK, DIMEI PEEK and TLIF PEEK are equivalent to predicate devices.

Key Metrics

Not Found

Predicate Device(s)

K083661

Reference Device(s)

P980048 S3, K071724, K073351, K081968, K091088, K082310, P960025, P950019, K090707

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3080 Intervertebral body fusion device.

(a)
Identification. An intervertebral body fusion device is an implanted single or multiple component spinal device made from a variety of materials, including titanium and polymers. The device is inserted into the intervertebral body space of the cervical or lumbosacral spine, and is intended for intervertebral body fusion.(b)
Classification. (1) Class II (special controls) for intervertebral body fusion devices that contain bone grafting material. The special control is the FDA guidance document entitled “Class II Special Controls Guidance Document: Intervertebral Body Fusion Device.” See § 888.1(e) for the availability of this guidance document.(2) Class III (premarket approval) for intervertebral body fusion devices that include any therapeutic biologic (e.g., bone morphogenic protein). Intervertebral body fusion devices that contain any therapeutic biologic require premarket approval.
(c)
Date premarket approval application (PMA) or notice of product development protocol (PDP) is required. Devices described in paragraph (b)(2) of this section shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three faces in profile, stacked one behind the other, representing people. The faces are rendered in a simple, abstract style.

June 10, 2015

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

Osteomed Implantes, LTDA % Mr. J.D. Webb The OrthoMedix Group, Incorporated 1001 Oakwood Boulevard Round Rock, Texas 78681

Re: K143572

Trade/Device Name: Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK, Intersomatic Transforaminal - TLIF PEEK Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral body fusion device Regulatory Class: Class II Product Code: ODP, MAX Dated: May 3, 2015 Received: June 5, 2015

Dear Mr. Webb:

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

1

Page 2 - Mr. J.D. Webb

(21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set 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 contact the Division of Industry and Consumer Education 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. 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 Industry and Consumer Education 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,

Mark N. Melkerson -S

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

Enclosure

2

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

K143572

Page 1 of 1

510(k) Number (if known) K143572

Device Name

Intersomatic Cervical Device - DICOM PEEK, Intervertebral Space Maintenance Device - DIMEI PEEK, Intersomatic Transforaminal - TLIF PEEK

Indications for Use (Describe)

The Intersomatic Cervical Device - DICOM PEEK is intended for anterior interbody spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one disc level (C2-C3 disc to the C7-TI disc). Cervical degenerative disc disease is defined as neck pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. This device is intended for use with additional supplemental fixation systems and autogenous bone graft implanted via an open, anterior approach. Patients should have at least six weeks of non-operative treatment prior to treatment with intervertebral cage.

The Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal - TLIF PEEK is indicated for intervertebral body spinal fusion procedures in skeletally mature patients with degenerative disc disease (DDD) at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis at the involved level(s). DIMEI and TLIF Spinal Implants are to be used with autogenous bone graft and implanted via an open posterior or transforaminal approach. The DIMEI and TLIF Spinal Implant is to be used with additional supplemental fixation. Patients should have at least six (6) months of non-overative treatment with an intervertebral cage.

Type of Use (Select one or both, as applicable)

☑ Prescription Use (Part 21 CFR 801 Subpart D)
☐ Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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3

510(k) Summary: DICOM PEEK and DIMEI PEEK

Date PreparedApril 20, 2015
Submitted ByOsteomed Implantes, LTDA
Washington Luiz Road, km 172
Condomínio Conpark - Rua 6, S/N
CEP 13501-600
Rio Claro - SP
BRAZIL
(19) 3532-3411 Tele
ContactJ.D. Webb
1001 Oakwood Blvd
Round Rock, TX 78681
512-388-0199 Tele
512-692-3699 Fax
e-mail: jdwebb@orthomedix.net
Trade NameIntersomatic Cervical Device - DICOM PEEK
Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK
Intersomatic Transforaminal - TLIF PEEK
Common Nameintervertebral body fusion device
Classification Nameintervertebral body fusion device - cervical
intervertebral body fusion device - lumbar
ClassII
Product CodeODP
MAX
CFR Section21 CFR section 888.3080
Device PanelOrthopedic
Primary Predicate
DeviceStryker Spine AVS® TL PEEK Spacer (K083661)
Secondary Predicate
DevicesZimmer, BAK/C Vista Interbody Fusion (P980048 S3)
Spinal Elements, Crystal Cervical/Lucent Straight Interbody Cages
K071724/K073351/K081968)
LDR Spine Cervical Interbody Fusion System (K091088)
SeaSpine, Pacifica Cage (K082310)
DePuy, Brantigan I/F Cage (P960025)
Surgical Dynamic, Ray Threaded Lumbar Fusion Cage (P950019)
Meditech Advisors, Talos PLIF (K090707)

4

| Device Description | The Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral
Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal -
TLIF PEEK were developed as implants for the stabilization of the cervical and
lumbar spinal column. The implants have ridges on both their inferior and
superior surfaces to prevent migration, and graft windows which help facilitate
bony integration. X-ray markers are integrated for visualization of the implants
during and after surgery. |
|------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Materials | Invibio® PEEK Optima LT1 (ASTM F2026)
Titanium alloy conforming to ASTM F136 |
| Substantial
Equivalence Claimed
to Predicate Devices | The Intersomatic Cervical Device - DICOM PEEK, Intersomatic Intervertebral
Space Maintenance Device - DIMEI PEEK and Intersomatic Transforaminal -
TLIF PEEK are substantially equivalent to the predicate devices in terms of
intended use, design, materials used, mechanical safety and performances. |
| Indications for Use | The Intersomatic Cervical Device - DICOM PEEK is intended for anterior
interbody spinal fusion procedures in skeletally mature patients with degenerative
disc disease (DDD) at one disc level (C2-C3 disc to the C7-T1 disc). Cervical
degenerative disc disease is defined as neck pain of discogenic origin with
degeneration of the disc confirmed by history and radiographic studies. This
device is intended for use with additional supplemental fixation systems and
autogenous bone graft implanted via an open, anterior approach. Patients should
have at least six weeks of non-operative treatment prior to treatment with
intervertebral cage.

The Intersomatic Intervertebral Space Maintenance Device - DIMEI PEEK and
Intersomatic Transforaminal - TLIF PEEK is indicated for intervertebral body
spinal fusion procedures in skeletally mature patients with degenerative disc
disease (DDD) at one or two contiguous levels from L2-S1. DDD is defined as
discogenic back pain with degeneration of the disc confirmed by patient history
and radiographic studies. These DDD patients may also have up to Grade I
spondylolisthesis at the involved level(s). DIMEI and TLIF Spinal Implants are to
be used with autogenous bone graft and implanted via an open posterior or
transforaminal approach. The DIMEI and TLIF Spinal Implant is to be used with
additional supplemental fixation. Patients should have at least six (6) months of
non-operative treatment prior to treatment with an intervertebral cage. |
| Non-clinical Test
Summary | The following analyses were conducted:
• Static and dynamic compression per ASTM F2077
• Static and dynamic torsion per ASTM F2077
• Subsidence per ASTM F2267

The results of these evaluations indicate that the DICOM PEEK, DIMEI PEEK
and TLIF PEEK are equivalent to predicate devices. |
| Clinical Test Summary | No clinical studies were performed |
| Conclusions: Non-
clinical and Clinical | Osteomed Implantes considers the DICOM PEEK, DIMEI PEEK and TLIF PEEK
to be equivalent to the predicate devices listed above. This conclusion is based
upon the devices' similarities in principles of operation, technology, materials and
indications for use |