(63 days)
JULIET® LL Lumbar Interbody Device is indicated for intervertebral body 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 1 spondylolisthesis or retrolisthesis at the involved level(s). These spinal implants are to be used with autogenous bone graft. JULIET® LL Lumbar Interbody Device is to be used with supplemental fixation. Patients should have at least six (6) months of non-operative treatment prior to treatment
The JULIETLL Titanium Lateral Lumbar cages are rectangle-shaped intervertebral body fusion devices with a central cavity that can be filled with bone graft (autograft) to facilitate fusion. The JULIETLL intervertebral body fusion spacer comes in various sizes and footprints in order to fulfill surgeons' needs and accommodate different patient anatomies.
The JULIETLL system is made of Titanium Ti 6Al-4V ELI conforming to ASTM F136 and ISO 5832-3.
The JULIETLL Titanium Lateral Lumbar cages are supplied with dedicated surgical instruments (reusable - provided non sterile).
This document describes the FDA 510(k) clearance for the JULIET® LL Lateral Lumbar Cage, an intervertebral body fusion device. The acceptance criteria and supporting studies are primarily related to the mechanical performance and biocompatibility of the device, rather than diagnostic accuracy as would be presented for an AI/ML medical device.
1. Table of Acceptance Criteria and Reported Device Performance
| Acceptance Criteria Category | Specific Test/Standard | Acceptance Criteria | Reported Device Performance | Study Type |
|---|---|---|---|---|
| Mechanical Performance | Static axial compression (ASTM F2077) | Not explicitly stated (implied to be equivalent to predicate) | Not explicitly stated (implied to be equivalent to predicate) | Non-clinical (bench testing) |
| Mechanical Performance | Static shear compression (ASTM F2077) | Not explicitly stated (implied to be equivalent to predicate) | Not explicitly stated (implied to be equivalent to predicate) | Non-clinical (bench testing) |
| Mechanical Performance | Subsidence testing (ASTM F2267) | Not explicitly stated (implied to be equivalent to predicate) | Not explicitly stated (implied to be equivalent to predicate) | Non-clinical (bench testing) |
| Biocompatibility | Bacterial Endotoxin Testing (USP <85>) | Endotoxin limit of 20 EU / device | Not explicitly stated (implied to meet 20 EU/device) | Non-clinical (laboratory testing) |
| Design & Material Equivalence | Similar material (Titanium Ti 6Al-4V ELI conforming to ASTM F136 and ISO 5832-3) | Equivalent to predicate | Meets ASTM F136 and ISO 5832-3 | Design/Material Comparison |
| Intended Use Equivalence | Same indicated use | Equivalent to predicate | Same indications for use | Clinical/Regulatory Comparison |
2. Sample Size Used for the Test Set and Data Provenance
This document describes a medical device (spinal implant), not a diagnostic AI/ML system. Therefore, the concepts of "test set" and "data provenance" in the context of clinical images or patient data are not directly applicable.
- Mechanical Testing: For mechanical tests (static axial compression, static shear compression, subsidence testing), the sample size would refer to the number of physical devices tested. This information is not explicitly stated in the provided document. The tests were performed on the predicate device (JULIET®LL Titanium Lateral Lumbar cages, K141135), and a rationale of "verification activity and validation activity" was used to demonstrate equivalence for the modified devices.
- Bacterial Endotoxin Testing: The sample size would refer to the number of devices or material samples tested for endotoxins. This information is not explicitly stated.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of those Experts
Not applicable for a physical medical device clearance based on mechanical testing and biocompatibility. Ground truth in this context is established by adherence to engineering standards and material specifications, not by expert interpretation of data.
4. Adjudication Method for the Test Set
Not applicable for a physical medical device clearance. Adjudication methods are typically used for establishing ground truth in clinical studies involving interpretation (e.g., by radiologists).
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done
No, an MRMC comparative effectiveness study was not conducted. This type of study is relevant for evaluating the impact of AI on human reader performance in diagnostic tasks, which is not the subject of this 510(k) clearance for a spinal implant.
6. If a Standalone Study (i.e., algorithm only without human-in-the-loop performance) was done
No, a standalone study in the context of an AI algorithm was not done. This 510(k) is for a physical medical device. The "standalone" performance here refers to the device's mechanical integrity and biocompatibility, which were evaluated through non-clinical bench testing.
7. The Type of Ground Truth Used
The ground truth for this device clearance is based on:
- Engineering Standards: Adherence to established ASTM (American Society for Testing and Materials) and ISO (International Organization for Standardization) standards for mechanical testing (ASTM F2077, ASTM F2267) and material specification (ASTM F136, ISO 5832-3).
- Biocompatibility Standards: Adherence to USP (United States Pharmacopeia) standard for bacterial endotoxin testing (USP <85>).
- Predicate Device Equivalence: The primary ground truth for the modified device is its substantial equivalence to the performance and safety of the previously cleared predicate device (JULIET® LL, K141135).
8. The Sample Size for the Training Set
Not applicable. There is no AI model or "training set" in the context of this traditional medical device clearance. The "training" for such devices involves adherence to manufacturing processes and quality control systems.
9. How the Ground Truth for the Training Set was Established
Not applicable. As there is no "training set," there is no ground truth established in this manner for the submitted device.
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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
September 12, 2016
SPINEART Mr. Franck Pennesi Director of Industry & Quality International Center Cointrin 20 Route De Pré-bois CP1813 1215 Geneva, 15 SWITZERLAND
Re: K161888
Trade/Device Name: JULIET® LL Lateral Lumbar Cage Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral body fusion device Regulatory Class: Class II Product Code: MAX Dated: August 12, 2016 Received: August 15, 2016
Dear Mr. Pennesi:
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 Parts 801); medical device reporting (reporting of medical devicerelated 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/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,
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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Indications for Use
Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.
Page 1 of 1
510(k) Number (if known) K161888
Device Name JULIET® LL Lateral Lumbar Cage
Indications for Use (Describe)
JULIET®LL Lumbar Interbody Device is indicated for intervertebral body 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 1 spondylolisthesis or retrolisthesis at the involved level(s). These spinal implants are to be used with autogenous bone graft. JULIET®LL Lumbar Interbody Device is to be used with 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)
2 Prescription Use (Part 21 CFR 801 Subpart D)
_ Over-The-Counter Use (21 CFR 801 Subpart C)
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FOR FDA USE ONLY
Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)
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510(k) SUMMARY
| Submitted by | SPINEART |
|---|---|
| International Center Cointrin | |
| 20 route de pré-bois | |
| CP1813 | |
| 1215 GENEVA 15 | |
| SWITZERLAND | |
| Contacts | Franck PENNESI Director of Industry & Quality |
| Phone : +41 22 799 40 25 Fax : +41 22 799 40 26 | |
| Mail : fpennesi@spineart.com | |
| Regulatory contact : Dr Isabelle DRUBAIX (Idée Consulting)idrubaix@nordnet.fr | |
| Date Prepared | September 7th 2016 |
| Common Name | Intervertebral body fusion device |
| Trade Name | JULIET® LL Lateral Lumbar Cage |
| Classification Name | Intervertebral Fusion Device With Bone Graft, Lumbar |
| Class | II |
| Product Code | MAX |
| CFR section | 888.3080 |
| Device panel | ORTHOPEDIC |
| Legally marketed predicate device | Primary predicate: JULIET® LL (K141135) manufactured by Spineart |
| Indications for use | JULIET® LL Lumbar Interbody Device is indicated for intervertebral body 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 1 spondylolisthesis or retrolisthesis at the involved level(s). These spinal implants are to be used with autogenous bone graft. JULIET® LL Lumbar Interbody Device is to be used with supplemental fixation. Patients should have at least six (6) months of non-operative treatment prior to treatment |
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| Description of the device | The JULIETLL Titanium Lateral Lumbar cages are rectangle-shaped intervertebral body fusion devices with a central cavity that can be filled with bone graft (autograft) to facilitate fusion. The JULIETLL intervertebral body fusion spacer comes in various sizes and footprints in order to fulfill surgeons' needs and accommodate different patient anatomies.The JULIETLL system is made of Titanium Ti 6Al-4V ELI conforming to ASTM F136 and ISO 5832-3.The JULIETLL Titanium Lateral Lumbar cages are supplied with dedicated surgical instruments (reusable - provided non sterile). |
|---|---|
| Technological Characteristics | The modification to JULIET®LL Titanium Lateral Lumbar cages consists of the addition of lordotic version of the range of existing spacers having a width of 17 mm, a height ranging from 08 to 16 mm, and a length ranging from 40 to 60 mm. |
| Discussion of Testing | The following non-clinical tests were initially conducted on JULIET®LL Titanium Lateral Lumbar cages (K141135): Static axial compression, Static shear compression according to ASTM F2077 and subsidence testing according to ASTM F2267. A rationale based on verification activity and validation activity demonstrate that the devices added to the JULIET®LL Titanium Lateral Lumbar range of products are as safe, as effective, and performs at least as safely and effectively as predicate JULIET®LL Titanium Lateral Lumbar cages (K141135). No additional testing has been performed.Bacterial endotoxin testing as specified in USP <85> standard is used for pyrogenicity testing to achieve the Endotoxin limit of 20 EU / device. |
| Conclusion | The extended range of JULIET®LL Titanium Lateral Lumbar cages is substantially equivalent to its predicate devices in terms of intended use, labeling, material, design, mechanical properties and function. Verification Activity and Validation Activity demonstrate that the added devices are as safe, as effective, and perform at least as safely and effectively as its predicates (K141135). |
§ 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.