K Number
K172214
Device Name
Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters
Manufacturer
Date Cleared
2017-08-23

(30 days)

Product Code
Regulation Number
888.3027
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters are intended to be used for the reduction and fixation of fractures and/or creation of a void in cancellous bone in the spine. This includes use during percutaneous vertebral augmentation. This system is to be used with cleared spinal polymethylmethacrylate (PMMA) bone cements for use during percutaneous vertebral augmentation, such as kyphoplasty.
Device Description
The inflation of the balloon serves to create a cavity in the vertebral body, compressing the cancellous bone and/or move cortical bone, thereby reducing the fracture and preventing cement leakage, while still allowing for cement interdigitation. Modified Winch Kypholplasy (15 and 20 mm) 11 Gauge balloon catheters fit through a 10 Gauge cannula allowing a minimally invasive kyhoplasty procedure. The low pre-inflation profile (low wrapping profile of folded balloon) enables their insertion into these small working cannulas. The stiff distal end of the balloon catheter provides rigidity for smooth insertion while the flexible proximal catheter allows for easy maneuverability. The inflating component, laserbonded to the shaft, is a low-pressure elastomeric balloon of tubular shape (which is inflated by volume, not pressure). The inflation can expand the balloon several times its original size, it can be inflated to precise dimensions and retain well defined shapes and high pressures and when the pressure is released, it recovers close to its original size and shape, re-folding back to similar original profiles.
More Information

Not Found

No
The summary describes a mechanical device (balloon catheter) used in a surgical procedure. There is no mention of software, algorithms, or data processing that would indicate the use of AI/ML.

Yes
The device is intended for reduction and fixation of fractures and creation of a void in cancellous bone in the spine, which are therapeutic actions.

No

Explanation: The device is a surgical tool (balloon catheter) used for the reduction and fixation of fractures and/or creation of a void in cancellous bone in the spine. It is not described as detecting, monitoring, or analyzing any physiological data for diagnostic purposes.

No

The device description clearly details physical components like balloon catheters, cannulas, and a stiff distal end, indicating it is a hardware device, not software-only.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly describes a device used within the body for a surgical procedure (reduction and fixation of fractures, creation of a void in bone, percutaneous vertebral augmentation).
  • Device Description: The description details a physical device (balloon catheter) designed to be inserted into the body and inflated to perform a mechanical action.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.

IVD devices are used outside the body to analyze biological samples. This device is used inside the body for a therapeutic and structural purpose.

N/A

Intended Use / Indications for Use

The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters are intended to be used for the reduction and fixation of fractures and/or creation of a void in cancellous bone in the spine. This includes use during percutaneous vertebral augmentation. This system is to be used with cleared spinal polymethylmethacrylate (PMMA) bone cements for use during percutaneous vertebral augmentation, such as kyphoplasty.

Product codes

NDN, HRX

Device Description

The inflation of the balloon serves to create a cavity in the vertebral body, compressing the cancellous bone and/or move cortical bone, thereby reducing the fracture and preventing cement leakage, while still allowing for cement interdigitation.

Modified Winch Kypholplasy (15 and 20 mm) 11 Gauge balloon catheters fit through a 10 Gauge cannula allowing a minimally invasive kyhoplasty procedure. The low pre-inflation profile (low wrapping profile of folded balloon) enables their insertion into these small working cannulas.

The stiff distal end of the balloon catheter provides rigidity for smooth insertion while the flexible proximal catheter allows for easy maneuverability. The inflating component, laserbonded to the shaft, is a low-pressure elastomeric balloon of tubular shape (which is inflated by volume, not pressure). The inflation can expand the balloon several times its original size, it can be inflated to precise dimensions and retain well defined shapes and high pressures and when the pressure is released, it recovers close to its original size and shape, re-folding back to similar original profiles.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cancellous bone in the spine

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)

Using design FMECA, G21 identified the necessary verification and validation testing to assure the new balloon met the catheters original performance specifications. All testing demonstrated that the modified catheters continues to meet all performance specifications.

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

Not Found

Predicate Device(s)

K152557

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.3027 Polymethylmethacrylate (PMMA) bone cement.

(a)
Identification. Polymethylmethacrylate (PMMA) bone cement is a device intended to be implanted that is made from methylmethacrylate, polymethylmethacrylate, esters of methacrylic acid, or copolymers containing polymethylmethacrylate and polystyrene. The device is intended for use in arthroplastic procedures of the hip, knee, and other joints for the fixation of polymer or metallic prosthetic implants to living bone.(b)
Classification. Class II (special controls). The special control for this device is the FDA guidance document entitled “Class II Special Controls Guidance Document: Polymethylmethacrylate (PMMA) Bone Cement.”

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

G-21 S.R.L. % Mr. Paul Speidel Senior Regulatory/Quality Consultant ROMIS. Inc. 110 Haverhill Road Suite 526 Amesbury, Massachusetts 01913

August 23, 2017

Re: K172214

Trade/Device Name: Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters Regulation Number: 21 CFR 888.3027 Regulation Name: Polymethylmethacrylate (PMMA) bone cement Regulatory Class: Class II Product Code: NDN, HRX Dated: July 21, 2017 Received: July 24, 2017

Dear Mr. Speidel:

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

Image /page/0/Picture/11 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 a stylized image of three human profiles facing to the right, stacked on top of each other.

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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 devicerelated 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" (21 CFR 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

510(k) Number (if known): K172214

Device Name: Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters

Indications for Use:

The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters are intended to be used for the reduction and fixation of fractures and/or creation of a void in cancellous bone in the spine. This includes use during percutaneous vertebral augmentation. This system is to be used with cleared spinal polymethylmethacrylate (PMMA) bone cements for use during percutaneous vertebral augmentation, such as kyphoplasty.

Prescription Use X____________________________________________________________________________________________________________________________________________________ AND/OR Over-The-Counter Use ________ (Part 21 CFR 801 Subpart D) (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

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510(k) SUMMARY

G-21 S.R.L.'s Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters

| Submitter | G-21 S.R.L.
Maurizio Foroni
Via S. Pertini, 8
San Possidonio, Italy 41039
Phone: +39 0535 30312 |
|--------------------------|-------------------------------------------------------------------------------------------------------------|
| Contact Person: | Barry Sands
RQMIS, Inc.
110 Haverhill Road, Suite 526
Amesbury, MA 01913
Phone: 978-358-7307 |
| Date Prepared: | July 21, 2017 |
| Name of Device | Modified Winch Kyphoplasty
(15 and 20 mm) 11 Gauge
Balloon Catheters |
| Name/Address of Sponsor: | G-21
Maurizio Foroni
Via S. Pertini, 8
San Possidonio, Italy 41039 |

Common or Usual Name

Kyphoplasty Balloon Catheter

Classification Name

Cement, Bone, Vertebroplasty, Class II (21 CFR 888.3027) Arthroscope, Class II (21 CFR, Sec. 888.1100)

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Product Codes

HRX and NDN

Predicate Device

K152557, Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters

Intended Use / Indications for Use

Indications for Use:

The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters are intended to be used for the reduction and fixation of fractures and/or creation of a void in cancellous bone in the spine. This includes use during percutaneous vertebral augmentation. This system is to be used with cleared spinal polymethylmethacrylate (PMMA) bone cements for use during percutaneous vertebral augmentation, such as kyphoplasty.

Technological Characteristics

The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters are primarily composed of polyurethane, polycarbonate, and polyether/polyamide materials. A Silicone lubricant is provided to facilitate insertion of the catheters. This premarket submission represents a change to the balloon material to a different type of polyurethane.

Device Description

The inflation of the balloon serves to create a cavity in the vertebral body, compressing the cancellous bone and/or move cortical bone, thereby reducing the fracture and preventing cement leakage, while still allowing for cement interdigitation.

Modified Winch Kypholplasy (15 and 20 mm) 11 Gauge balloon catheters fit through a 10 Gauge cannula allowing a minimally invasive kyhoplasty procedure. The low pre-inflation profile (low wrapping profile of folded balloon) enables their insertion into these small working cannulas.

Image /page/4/Picture/12 description: The image shows a medical device, possibly a catheter or similar instrument, laid out horizontally. It features a connector at one end, a long, slender tube, and a tip at the opposite end, which is encircled and labeled 'A'. The device appears to be designed for insertion into the body, with the connector facilitating attachment to other medical equipment.

Figure 1: Modified Winch Kyphoplasty 11 Gauge Balloon Catheter

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Image /page/5/Picture/0 description: This image is a figure that shows an isometric view of the modified winch kyphoplasty 11 gauge balloon catheter. The catheter is long and thin, with a balloon at the end. The catheter is used to treat vertebral compression fractures. The figure is labeled as Figure 2.

The stiff distal end of the balloon catheter provides rigidity for smooth insertion while the flexible proximal catheter allows for easy maneuverability. The inflating component, laserbonded to the shaft, is a low-pressure elastomeric balloon of tubular shape (which is inflated by volume, not pressure). The inflation can expand the balloon several times its original size, it can be inflated to precise dimensions and retain well defined shapes and high pressures and when the pressure is released, it recovers close to its original size and shape, re-folding back to similar original profiles.

Performance Data

Using design FMECA, G21 identified the necessary verification and validation testing to assure the new balloon met the catheters original performance specifications. All testing demonstrated that the modified catheters continues to meet all performance specifications.

Substantial Equivalence

G-21 used dFMECA to determine substantial equivalence. The Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters and the K152557 predicate device have the same intended use/indications for use, equivalent technical characteristics, and identical principles of operation.

G-21 submits the information in this Premarket Notification to demonstrate that, for the purposes of FDA's regulation of medical devices, the Modified Winch Kyphoplasty (15 and 20 mm) 11 Gauge Balloon Catheters is substantially equivalent in indications, design principles, and performance standards to the predicate device.