K Number
K180369
Device Name
Intracept Intraosseous Nerve Ablation System (component Intracept RF Probe)
Date Cleared
2018-09-14

(214 days)

Product Code
Regulation Number
882.4725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Intracept Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care, and is also accompanied by either Type 1 or Type 2 Modic changes on an MRI.
Device Description
The Intracept Intraosseous Nerve Ablation System (Intracept System) is comprised of two sterile, single-use components: - . The Intracept Access Instruments include introducers, cannulas and stylets that provide access to the intended site of radiofrequency (RF) ablation. - . The Intracept RF Probe conducts RF energy to the target location. To obtain the energy needed for tissue ablation, the Intracept RF Probe is used with the Relievant RF Generator (RFG). The Intracept System technique uses RF ablation of the basivertebral nerve for relief of chronic low back pain and involves a two-step process. First, utilizing the Access Instruments, based on a minimally invasive, transpedicular or extrapedicular approach, a cannula and stylets are placed into the vertebral body to create a path or channel to the terminus of the basivertebral foramen. The RF Probe is then placed into this channel at the terminus of the basivertebral foramen and controlled RF energy is delivered to ablate the basivertebral nerve. This nerve has been identified as a proprioceptive sensory nerve with enervation of the vertebral endplates.
More Information

Not Found

No
The description focuses on the mechanical and electrical components of the device and the RF ablation process. There is no mention of AI or ML in the intended use, device description, or performance studies.

Yes
The device is intended for the ablation of basivertebral nerves for the relief of chronic low back pain, which is a therapeutic intervention.

No

The device is an ablation system used for treating chronic low back pain by ablating basivertebral nerves, which is a therapeutic rather than a diagnostic function.

No

The device description explicitly states it is comprised of two sterile, single-use hardware components: Access Instruments and an RF Probe. It also mentions being used with an RF Generator.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices intended for use in vitro for the examination of specimens, including blood, tissue, and urine, derived from the human body, solely or principally for the purpose of providing information concerning a physiological or pathological state, or concerning a congenital abnormality, or to determine the safety and compatibility of potential donors and recipients, or to monitor therapeutic measures.
  • Device Function: The Intracept Intraosseous Nerve Ablation System is a surgical device used to directly ablate nerves within the vertebral body. It is used in vivo (within the living body) to treat pain, not to analyze samples in vitro.
  • Intended Use: The intended use clearly states it's for the "ablation of basivertebral nerves... for the relief of chronic low back pain." This is a therapeutic intervention, not a diagnostic test performed on a sample.
  • Device Components: The components are instruments for accessing and ablating tissue, not reagents or equipment for analyzing biological samples.

Therefore, the Intracept Intraosseous Nerve Ablation System falls under the category of a therapeutic medical device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Intracept Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care, and is also accompanied by either Type 1 or Type 2 Modic changes on an MRI.

Product codes

GXI

Device Description

The Intracept Intraosseous Nerve Ablation System (Intracept System) is comprised of two sterile, single-use components:

  1. The Intracept Access Instruments include introducers, cannulas and stylets that provide access to the intended site of radiofrequency (RF) ablation.
  2. The Intracept RF Probe conducts RF energy to the target location.
    To obtain the energy needed for tissue ablation, the Intracept RF Probe is used with the Relievant RF Generator (RFG).

The Intracept System technique uses RF ablation of the basivertebral nerve for relief of chronic low back pain and involves a two-step process. First, utilizing the Access Instruments, based on a minimally invasive, transpedicular or extrapedicular approach, a cannula and stylets are placed into the vertebral body to create a path or channel to the terminus of the basivertebral foramen. The RF Probe is then placed into this channel at the terminus of the basivertebral foramen and controlled RF energy is delivered to ablate the basivertebral nerve. This nerve has been identified as a proprioceptive sensory nerve with enervation of the vertebral endplates.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

L3 through S1 vertebrae

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)

Non-Clinical Performance Testing: Testing of the Intracept RF Probe demonstrated that the device met specifications and performance requirements, and supports demonstration of equivalence to the predicate device.

  • Biocompatibility Testing: RF Probe Tip (≤ 24 hour contact with Tissue/Bone/Dentin), RF Probe Handle (≤ 24 hour contact with Intact Skin) - PASS for Cytotoxicity, Sensitization, Acute Systemic Toxicity, Intracutaneous Reactivity.
  • Functional Testing: Corrosion, Transit, Gross Leaks, Seal Strength, Sterilization - All PASS.
  • Electrical Safety: IEC 60601-1, IEC 60601-2-2 - PASS.
  • Electromagnetic Compatibility (EMC): IEC 60601-1-2 - PASS.
  • Interface and Primary Operating Function Testing: SensTx® Chip assessed with Relievant RFG software recognition and integration of SensTx Chip - PASS.
  • Programmable Electrical Medical Systems (PEMS): IEC 60601-1 - PASS.
  • Simulated Use with Mechanical Testing: Met performance specifications for mechanical durability and simulated use, as well as compatibility with Access Instruments - PASS.
  • Usability: IEC 62366-1, IEC 60601-1-6 - PASS.

Clinical Performance Testing: Substantial equivalence is not dependent upon clinical data and no clinical testing was performed.

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

Not Found

Predicate Device(s)

Relievant Medsystems, Inc.: Intracept Intraosseous Nerve Ablation System (K153272)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 882.4725 Radiofrequency lesion probe.

(a)
Identification. A radiofrequency lesion probe is a device connected to a radiofrequency (RF) lesion generator to deliver the RF energy to the site within the nervous system where a lesion is desired.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" followed by the words "U.S. Food & Drug Administration" in a sans-serif font. The word "Administration" is on a separate line below "U.S. Food & Drug".

September 14, 2018

Relievant Medsystems Alex DiNello Chief Operating Officer 385 Moffett Park Drive, Suite 105 Sunnyvale, California 94089

Re: K180369

Trade/Device Name: Intracept Intraosseous Nerve Ablation System (component Intracept RF Probe) Regulation Number: 21 CFR 882.4725 Regulation Name: Radiofrequency lesion probe Regulatory Class: Class II Product Code: GXI Dated: August 13, 2018 Received: August 15, 2018

Dear Alex DiNello:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice

(https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely. Matthew C. Krueger -S

for Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K180369

Device Name

Intracept Intraosseous Nerve Ablation System

Indications for Use (Describe)

The Intracept Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care, and is also accompanied by either Type 1 or Type 2 Modic changes on an MRI.

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)

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3

510(k) SUMMARY

Applicant's Name and Address:

Relievant Medsystems, Inc. 385 Moffett Park Drive, Suite 105 Sunnyvale, CA 94089-1218

Contact Person:Laurie Hook
Telephone:650/368-1000
Facsimile:650/298-9205
Date Prepared:August 13, 2018
Device Name:
Device Generic Name:RF Ablation Catheter and Accessories
Device Trade Name:Intracept® Intraosseous Nerve Ablation System
Device Classification:II
Classification Name:Radiofrequency lesion probe
21 CFR 882.4725, Product Code GXI

Predicate Device:

Relievant Medsystems, Inc .: Intracept Intraosseous Nerve Ablation System (K153272)

Device Description:

The Intracept Intraosseous Nerve Ablation System (Intracept System) is comprised of two sterile, single-use components:

  • . The Intracept Access Instruments include introducers, cannulas and stylets that provide access to the intended site of radiofrequency (RF) ablation.
  • . The Intracept RF Probe conducts RF energy to the target location.

To obtain the energy needed for tissue ablation, the Intracept RF Probe is used with the Relievant RF Generator (RFG).

The Intracept System technique uses RF ablation of the basivertebral nerve for relief of chronic low back pain and involves a two-step process. First, utilizing the Access Instruments, based on a minimally invasive, transpedicular or extrapedicular approach, a cannula and stylets are placed into the vertebral body to create a path or channel to the terminus of the basivertebral foramen. The RF Probe is then placed into this channel at the terminus of the basivertebral foramen and controlled RF energy is delivered to ablate the basivertebral nerve. This nerve has been identified as a proprioceptive sensory nerve with enervation of the vertebral endplates.

Indications for Use

The Intracept Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care and is also accompanied by either Type 1 or Type 2 Modic changes on an MRI.

4

Substantial Equivalence

The subject device (Intracept RF Probe -- a component of the Intracept System) has the same intended use, has a similar overall design, and has the same operational characteristics as the predicate device (Flexible Bi-Polar RF Probe). Differences between the RF Probe devices do not raise different questions of safety and effectiveness for the subject device. In this submission, no modifications were made to the Intracept System's Access Instruments.

| Characteristic | Relievant Medsystems
Subject: | Relievant Medsystems
Predicate: | Comparison |
|-----------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------|----------------------|
| Device Component | Intracept RF Probe | Intracept Flexible Bi-Polar RF Probe (K153272) | |
| Intended Use | To ablate the basivertebral nerves of the L3 to S1 vertebrae | | Same |
| Indication | The INTRACEPT Intraosseous Nerve Ablation System is intended to be used in conjunction with RF generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration that has not responded to at least six months of conservative care, and is also accompanied by either Type 1 or Type 2 Modic changes on an MRI. | | Same |
| Principle | Provide bipolar RF energy to the tissue between and around the electrodes to achieve tissue ablation (i.e., cellular necrosis through thermal ablation) | | Same |
| Probe Shaft Length/Diameter | 335mm/1.98mm | 335mm/1.98mm | Same |
| Distal Tip Length | 4mm | 4mm | Same |
| Electrodes | Two | Two | Same |
| Safety cable | Tether welded to distal electrode ensures the electrode tip is retained for device removal | -- | Different |
| Tip temperature monitor/control | Thermocouple at distal tip | Thermocouple at distal tip | Same |
| SensTx Chip | Treatment parameters stored on microchip in RF Probe Handle | -- | Different |
| Treatment Parameters
Temperature
Ramp
Time | 85° C
1°C/second
15 minutes (900 seconds) | 85° C
1°C/second
15 minutes (900 seconds) | Same
Same
Same |
| Indicators | Circumferential markings (exit of Curved Cannula and clearance for electrode)
Light Ring | Circumferential markings (exit of Curved Cannula and clearance for electrode) | Different |
| Materials: Patient Contact | Stainless steel and Polyether Block Amide | Stainless steel and Polyether Block Amide | Same |
| Connect to RFG | Cable integrated with RF Probe | Separate cable | Different |
| Sterilization | Ethylene Oxide (EtO) | Ethylene Oxide (EtO) | Same |
| Use | Single | Single | Same |

5

Non-Clinical Performance Testing

Testing of the Intracept RF Probe demonstrated that the device met specifications and performane requirements, and supports demonstration of equivalence to the predicate device. Performance testing of the subject device was completed as follows:

TestTest Method SummaryResults
Biocompatibility TestingPatient contact materials are classified as tissue/bone/dentin