K Number
K190563
Device Name
4CIS PEEK PLIF Cage, 4CIS Pebble Beach PEEK PLIF Cage, 4CIS Torrey Pines PEEK TLIF Cage, 4CIS Dunes PEEK DLIF Cage, 4CIS Augusta PEEK ALIF Cage
Date Cleared
2019-09-18

(197 days)

Product Code
Regulation Number
888.3080
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Spinal Fusion Cage System is an intervertebral body fusion devices intended for use to skeletally mature patients with Degenerative Disk Disease (DDD) of the lumbar spine with up to Grade 1 Spondylolisthesis at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. Spinal Fusion Cage System is indicated to be used with autologous bone graft to facilitate fusion and are intended to be used with supplemental fixation. The device is to be used in patients who have had six months of nonoperative treatment.
Device Description
The Spinal Fusion Cage System is single component devices used to restore height of disc space via posterior, lateral, anterior, oblique approach and to facilitate lumbar intervertebral body fusion with maintaining physiological lordotic angulation of lumbar spine. To allow maximum preservation and ensure ample contact surfaces with bony endplate, a variety of shapes and sizes are available and each device has tantalum (ASTM F560) markers for ease of visualization on radiographs. Vertical square teeth on the top and the bottom surface prevent subsidence of the cage into the vertebral body while they increase the anchoring and prevent slipping or expulsion. To make solid fusion of intervertebral body, hollow space in the implant allows autologous bone graft material to be filled. The implant has safety proven structure and material (Polyetheretherketone, ASTM F2026) to promote biological synostosis and assures mechanical safety against load.
More Information

Not Found

No
The device description and performance studies focus on the mechanical properties and design of a physical implant for spinal fusion, with no mention of software, algorithms, or data processing that would indicate AI/ML.

Yes

The device is a Spinal Fusion Cage System, an intervertebral body fusion device used to treat Degenerative Disk Disease and facilitate spinal fusion, which are therapeutic medical interventions.

No

This device is a Spinal Fusion Cage System, an intervertebral body fusion device used for treatment, specifically to facilitate lumbar intervertebral body fusion, and not for diagnosing conditions.

No

The device description clearly outlines a physical implant made of Polyetheretherketone (PEEK) with tantalum markers, designed to be surgically implanted in the lumbar spine. This is a hardware device, not software.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The Spinal Fusion Cage System is a surgical implant designed to be placed within the body to facilitate bone fusion in the lumbar spine. It is a therapeutic device, not a diagnostic test.
  • Intended Use: The intended use clearly describes a surgical procedure for treating Degenerative Disk Disease, not a diagnostic process.
  • Device Description: The description details the physical characteristics and materials of the implant, not a diagnostic assay or testing method.
  • Input Imaging Modality: While radiographs are mentioned, they are used for visualization and assessment of the implant's placement and the fusion process after the device is implanted, not as the primary input for a diagnostic test performed in vitro.

Therefore, the Spinal Fusion Cage System falls under the category of a medical device (specifically, a surgical implant), not an In Vitro Diagnostic.

N/A

# Intended Use / Indications for Use
The Spinal Fusion Cage System is an intervertebral body fusion devices intended for use to skeletally mature patients with Degenerative Disk Disease (DDD) of the lumbar spine with up to Grade 1 Spondylolisthesis at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. Spinal Fusion Cage System is indicated to be used with autologous bone graft to facilitate fusion and are intended to be used with supplemental fixation. The device is to be used in patients who have had six months of nonoperative treatment.

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

# Device Description
The Spinal Fusion Cage System is single component devices used to restore height of disc space via posterior, lateral, anterior, oblique approach and to facilitate lumbar intervertebral body fusion with maintaining physiological lordotic angulation of lumbar spine. To allow maximum preservation and ensure ample contact surfaces with bony endplate, a variety of shapes and sizes are available and each device has tantalum (ASTM F560) markers for ease of visualization on radiographs. Vertical square teeth on the top and the bottom surface prevent subsidence of the cage into the vertebral body while they increase the anchoring and prevent slipping or expulsion. To make solid fusion of intervertebral body, hollow space in the implant allows autologous bone graft material to be filled. The implant has safety proven structure and material (Polyetheretherketone, ASTM F2026) to promote biological synostosis and assures mechanical safety against load.

# Mentions image processing
Not Found

# Mentions AI, DNN, or ML
Not Found

# Input Imaging Modality
Not Found

# Anatomical Site
lumbar spine (L2-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)
Mechanical testing (static axial compression, static compression-shear, static subsidence and dynamic axial compression) was conducted in accordance with ASTM F2077-14 and F2267-04. Above non-clinical performance data in the form of a comprehensive literature review was provided in support of substantial equivalence of the subject device.

# 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.
[K092162](https://510k.innolitics.com/search/K092162), [K072970](https://510k.innolitics.com/search/K072970), [K073202](https://510k.innolitics.com/search/K073202)

# 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/0 description: The image contains the logos of the Department of Health & Human Services and the U.S. Food & Drug Administration (FDA). The Department of Health & Human Services logo is on the left, featuring a stylized human figure. To the right of that is the FDA logo, with the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG" in blue, and "ADMINISTRATION" in a smaller font below.

Solco Biomedical Co., Ltd. % Hwi-geun Yu Manager 154 Seotan-ro, Seotan-myeon, Pyeongtaek, Gyeonggi-do, 17704, Republic of Korea

Re: K190563

Trade/Device Name: 4CIS® PEEK PLIF Cage, 4CIS® Pebble Beach PEEK PLIF Cage, 4CIS® Torrey Pines PEEK TLIF Cage, 4CIS® Dunes PEEK DLIF Cage, 4CIS® Augusta PEEK ALIF Cage Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral Body Fusion Device Regulatory Class: Class II Product Code: MAX Dated: August 14, 2019 Received: August 19, 2019

September 18, 2019

Dear Hwi-geun Yu:

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

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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) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-re-ulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance)and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

for Melissa Hall Assistant Director DHT6B: Division of Spinal Devices OHT6: Office of Orthopedic Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2020 See PRA Statement below.

510(k) Number (if known)

K190563

Device Name

Spinal Fusion Cage System (4CIS® PEEK PLIF Cage, 4CIS® Pebble Beach PEEK PLIF Cage, 4CIS® Torrey Pines PEEK TLIF Cage , 4CIS® Dunes PEEK DLIF Cage, 4CIS® Augusta PEEK ALIF Cage)

Indications for Use (Describe)

The Spinal Fusion Cage System is an intervertebral body fusion devices intended for use to skeletally mature patients with Degenerative Disk Disease (DDD) of the lumbar spine with up to Grade 1 Spondylolisthesis at one or two contiguous levels from L2-S1. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. Spinal Fusion Cage System is indicated to be used with autologous bone graft to facilitate fusion and are intended to be used with supplemental fixation. The device is to be used in patients who have had six months of nonoperative treatment.

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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510(k) Summary

SubmitterSolco Biomedical Co., Ltd.
154 Seotan-ro, Seotan-myeon, Pyeongtaek, Gyeonggi-do, 17704
Republic of Korea
Phone. +82-31-664-4101
Fax. +82-31-663-8983
Contact PersonHwi-geun Yu
154 Seotan-ro, Seotan-myeon, Pyeongtaek, Gyeonggi-do,
17704 Republic of Korea
Phone: +82)31-610-4091
Fax: +82)31-663-8983
Submission DateMar 01, 2019
Trade / Proprietary nameSpinal Fusion Cage System (4CIS® Augusta PEEK ALIF Cage,
4CIS® Dunes PEEK DLIF Cage, 4CIS® Torrey Pines PEEK TLIF
Cage, 4CIS® Pebble Beach PEEK PLIF Cage, 4CIS® PEEK PLIF
Cage)
Common / Usual NameSpinal Fusion Cage System
Classification NameIntervertebral body fusion device with bone graft, lumbar
Classification CodeMAX
Regulatory ClassClass II
Regulation Number888.3080
Predicate Device4CIS® PEEK PLIF and TLIF Cage System (K092162, SE
01/06/2010) [Solco Biomedical Co., Ltd.] – Primary Predicate
PATRIOTTM Spacers (ContinentalTM ALIF Spacer,
TransContinentalTM LLIF Spacer) (K072970, SE 01/18/2008)
[GLOBUS MEDICAL, INC.] – Additional Predicate
ARDIS SPACER (K073202, SE 01/30/2008) [ABBOTT SPINE,
INC.] – Additional Predicate
Description of DeviceThe Spinal Fusion Cage System is single component devices used
to restore height of disc space via posterior, lateral, anterior, oblique
approach and to facilitate lumbar intervertebral body fusion with
maintaining physiological lordotic angulation of lumbar spine. To
allow maximum preservation and ensure ample contact surfaces
with bony endplate, a variety of shapes and sizes are available and
each device has tantalum (ASTM F560) markers for ease of
visualization on radiographs. Vertical square teeth on the top and
the bottom surface prevent subsidence of the cage into the vertebral
body while they increase the anchoring and prevent slipping or
expulsion. To make solid fusion of intervertebral body, hollow
space in the implant allows autologous bone graft material to be
filled. The implant has safety proven structure and material
(Polyetheretherketone, ASTM F2026) to promote biological
synostosis and assures mechanical safety against load.
Indication for UseThe Spinal Fusion Cage System is an intervertebral body fusion
devices intended for use to skeletally mature patients with
Degenerative Disk Disease (DDD) of the lumbar spine with up to
Grade 1 Spondylolisthesis at one or two contiguous levels from L2-
S1. DDD is defined as discogenic back pain with degeneration of the
disc confirmed by history and radiographic studies. Spinal Fusion
Cage System is indicated to be used with autologous bone graft to
facilitate fusion and are intended to be used with supplemental
fixation. The device is to be used in patients who have had six
months of non-operative treatment.
Comparison of
Technological
Characteristics with the
Predicate DevicesThe subject device and all the predicates have the same or similar
indications for use statements. The subject device is composed of the
same material as the predicate devices conforming to recognized
industry standards for permanent implants and surgical orthopedic
instruments. All they have similar basic design features and functions
as well as those dimensions. The subject device and cited predicate
devices are provided non-sterile for single use only. The subject
device demonstrated equivalent mechanical performance to the cited
predicate device under the same test conditions.
Performance DataMechanical testing (static axial compression, static compression-
shear, static subsidence and dynamic axial compression) was
conducted in accordance with ASTM F2077-14 and F2267-04.
Above non-clinical performance data in the form of a comprehensive
literature review was provided in support of substantial equivalence
of the subject device.

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5

| Conclusion | The overall technology characteristics and mechanical performance
data lead to the conclusion that the subject device is substantially
equivalent to legally marketed predicate devices. |

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