K Number
K152512
Device Name
Half Dome Posterior Lumbar Interbody System
Manufacturer
Date Cleared
2016-01-28

(148 days)

Product Code
Regulation Number
888.3080
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Half Dome Posterior Lumbar Interbody System are indicated for intervertebral body fusion procedures in skeletally mature patients with degenerative disc disease (DDD) of the lumbar spine at one or two contiguous levels from L1-L2 to LS-S1. DDD is defined as discogenic with degeneration of the disc confirmed by history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis or retrolisthesis at the involved level(s). Half Dome implants are to be used with autogenous bone graft and supplemental fixation. Patients should have at least six (6) months of non-operative treatment with an intervertebral cage.
Device Description
The Half Dome Posterior Lumbar Interbody TLIF and OTLIF are implants developed for the substitution of the classical autogenous bone graft blocks. They are available in a range of footprints and heights to suit the individual pathology and anatomical conditions of the patient. The implants have a hollow center to allow placement of autogenous bone graft. The superior and inferior surfaces are open to promote contact of the bone graft with the vertebral end plates, allowing bone growth (arthrodesis). X-ray markers allow the position to be determined post-op.
More Information

K082310, K100089, P960025, P950019, K071724/K081968

Not Found

No
The 510(k) summary describes a physical interbody fusion device and its mechanical testing, with no mention of AI, ML, image processing, or data-driven algorithms.

Yes
The device is described as an implant used for intervertebral body fusion procedures to treat degenerative disc disease, facilitating bone growth and acting as a substitute for bone graft blocks. These actions are therapeutic in nature, aimed at treating a medical condition and restoring function.

No

The device description indicates it is an implant for intervertebral body fusion procedures, not a diagnostic tool.

No

The device description clearly states it is an "implant" and describes physical characteristics like footprints, heights, a hollow center, and X-ray markers, indicating it is a physical medical device, not software.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Description: The provided text describes a surgical implant (a cage) designed to be placed within the lumbar spine to facilitate bone fusion. It is a physical device used in vivo (within the body) during a surgical procedure.
  • Intended Use: The intended use is for intervertebral body fusion procedures in patients with degenerative disc disease. This is a surgical treatment, not a diagnostic test performed on a specimen.

The device is a medical device, but specifically a surgical implant, not an IVD.

N/A

Intended Use / Indications for Use

The Half Dome Posterior Lumbar Interbody System are indicated for intervertebral body fusion procedures in skeletally mature patients with degenerative disc disease (DDD) of the lumbar spine at one or two contiguous levels from L1-L2 to LS-S1. DDD is defined as discogenic with degeneration of the disc confirmed by history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis or retrolisthesis at the involved level(s). Half Dome implants are to be used with autogenous bone graft and supplemental fixation. Patients should have at least six (6) months of non-operative treatment with an intervertebral cage.

Product codes (comma separated list FDA assigned to the subject device)

MAX

Device Description

The Half Dome Posterior Lumbar Interbody TLIF and OTLIF are implants developed for the substitution of the classical autogenous bone graft blocks. They are available in a range of footprints and heights to suit the individual pathology and anatomical conditions of the patient. The implants have a hollow center to allow placement of autogenous bone graft. The superior and inferior surfaces are open to promote contact of the bone graft with the vertebral end plates, allowing bone growth (arthrodesis). X-ray markers allow the position to be determined post- op.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lumbar spine at one or two contiguous levels from L1-L2 to L5-S1

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)

Non-clinical Test Summary:
• Static and dynamic compression per ASTM F2077
• Subsidence per ASTM F2267
The results of these evaluations indicate that the Half Dome Posterior Lumbar Interbody System is equivalent to predicate devices.
Clinical Test Summary:
No clinical studies were performed

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K082310, K100089, P960025, P950019, K071724/K081968

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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.

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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" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized caduceus or a representation of human profiles.

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

January 28, 2016

Astura Medical % Mr. J. D. Webb Authorized Correspondent The Orthomedix Group, Incorporated 1001 Oakwood Boulevard Round Rock, Texas 78681

Re: K152512

Trade/Device Name: Half Dome Posterior Lumbar Interbody System Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral body fusion device Regulatory Class: Class II Product Code: MAX Dated: December 23, 2015 Received: December 28, 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 (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

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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 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/Resourcesfor You/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

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K152512

Device Name

Half Dome Posterior Lumbar Interbody System

Indications for Use (Describe)

The Half Dome Posterior Lumbar Interbody System are indicated for intervertebral body fusion procedures in skeletally mature patients with degenerative disc disease (DDD) of the lumbar spine at one or two contiguous levels from L1-L2 to LS-S1. DDD is defined as discogenic with degeneration of the disc confirmed by history and radiographic studies. These DDD patients may also have up to Grade I spondylolisthesis or retrolisthesis at the involved level(s). Half Dome implants are to be used with autogenous bone graft and supplemental fixation. Patients should have at least six (6) months of non-operative treatment with an intervertebral cage.

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

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

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

Form Approved: OMB No. 0910-0120 Expiration Date: December 31, 2013 See PRA Statement on last page.

K152512 Page 1 of 1

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510(k) Summary: Half Dome Posterior Lumbar Interbody System

Date PreparedDecember 10, 2015
Submitted ByAstura Medical
5670 El Camino Real, Suite B
Carlsbad, CA 92008
760-814-8047 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 NameHalf Dome Posterior Lumbar Interbody System
Common Nameintervertebral body fusion device
Classification NameIntervertebral body fusion device - lumbar
ClassII
Product CodeMAX
CFR Section21 CFR section 888.3080
Device PanelOrthopedic
Primary Predicate
DeviceSEASPINE Pacifica Cage (K082310)
Additional Predicate
DevicesSynthes T-PAL Spacer (K100089)
DePuy Brantigan I/F Cage (P960025)
Surgical Dynamics Ray Threaded Lumbar Fusion Cage (P950019)
Spinal Elements Lucent Cage (K071724/K081968)
Device DescriptionThe Half Dome Posterior Lumbar Interbody TLIF and OTLIF are implants
developed for the substitution of the classical autogenous bone graft blocks. They
are available in a range of footprints and heights to suit the individual pathology
and anatomical conditions of the patient. The implants have a hollow center to
allow placement of autogenous bone graft. The superior and inferior surfaces are
open to promote contact of the bone graft with the vertebral end plates, allowing
bone growth (arthrodesis). X-ray markers allow the position to be determined post-
op.
MaterialsVestakeep® PEEK per ASTM F2026
Tantalum per ASTM F560
Substantial
Equivalence Claimed
to Predicate DevicesThe Half Dome Posterior Lumbar Interbody System is substantially equivalent to
the predicate devices in terms of intended use, design, materials used, mechanical
safety and performances.
Indications for UseThe Half Dome Posterior Lumbar Interbody System is indicated for intervertebral
body fusion procedures in skeletally mature patients with degenerative disc
disease (DDD) of the lumbar spine at one or two contiguous levels from L1-L2 to
L5-S1. DDD is defined as discogenic pain with degeneration of the disc confirmed
by history and radiographic studies. These DDD patients may also have up to
Grade I spondylolisthesis or retrolisthesis at the involved level(s). Half Dome
implants are to be used with autogenous bone graft and supplemental fixation.
Patients should have at least six (6) months of non-operative treatment prior to
treatment with an intervertebral cage.
Non-clinical Test
SummaryThe following analyses were conducted:
• Static and dynamic compression per ASTM F2077
• Subsidence per ASTM F2267
The results of these evaluations indicate that the Half Dome Posterior Lumbar
Interbody System is equivalent to predicate devices.
Clinical Test SummaryNo clinical studies were performed
Conclusions: Non-
clinical and ClinicalAstura Medical considers the Half Dome Posterior Lumbar Interbody System 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

In accordance with 21 CFR 807.92 of the Federal Code of Regulations

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