(61 days)
The PERLA® TL posterior osteosynthesis system is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine: degenerative disc disease; spondylolisthesis; fracture; dislocation; scoliosis; kyphosis; spinal tumor; and failed previous fusion (pseudarthrosis). When used for posterior non-cervical pedicle screw fixation in pediatric patients, the PERLA® TL posterior osteosynthesis system is indicated as an adjunct to fusion to treat adolescent idiopathic scoliosis. The PERLA® TL posterior osteosynthesis system is intended to be used with autograft and/or allograft.
Pediatric pedicle screw fixation is limited to a posterior approach.
The PERLA® TL posterior osteosynthesis system consists of a range of screws, rods set screws, hooks, rod connectors and cross-connectors. These connecting components can be rigidly locked to the rod in a variety of configurations to be adapted for the individual case. The Perla®TL system is manufactured from medical grade titanium alloy and medical grade cobalt chromium conforming respectively to standards ASTM F136 and ASTM F1537.
The PERLA® TL posterior osteosynthesis implants are delivered either non sterile or sterile (gamma sterilization) and supplied with dedicated surgical instruments (reusable - provided non-sterile except for the drill supplied as sterile or not sterile). Bacterial endotoxin testing as specified in USP standard is used for pyrogenicity testing to achieve the Endotoxin limit of 20 EU / device.
This document pertains to the PERLA® TL posterior osteosynthesis system, a medical device, not an AI/ML device. Therefore, the questions related to AI/ML specific aspects such as sample sizes for test/training sets, data provenance, number of experts for ground truth, adjudication methods, MRMC studies, standalone performance, and ground truth establishment for training sets are not applicable.
However, based on the provided text, I can extract information regarding the device's acceptance criteria and the study conducted to prove it meets these criteria, focusing on the mechanical aspects relevant to this type of medical device.
1. Table of Acceptance Criteria and Reported Device Performance
| Acceptance Criteria (Bench Testing per ASTM Standards) | Reported Device Performance (PERLA® TL System) |
|---|---|
| Static Axial Gripping per ASTM F1798: Must meet or exceed the performance of the predicate device. | Results demonstrate comparable mechanical properties to the predicate device (ROMEO® 2 Posterior Osteosynthesis System). |
| Static Axial Torque Gripping per ASTM F1798: Must meet or exceed the performance of the predicate device. | Results demonstrate comparable mechanical properties to the predicate device (ROMEO® 2 Posterior Osteosynthesis System). |
| Static Compression Bending per ASTM F1717: Must meet or exceed the performance of the predicate device. | Results demonstrate comparable mechanical properties to the predicate device (ROMEO® 2 Posterior Osteosynthesis System). |
| Static Torsion per ASTM F1717: Must meet or exceed the performance of the predicate device. | Results demonstrate comparable mechanical properties to the predicate device (ROMEO® 2 Posterior Osteosynthesis System). |
| Dynamic Compression Bending per ASTM F1717: Must meet or exceed the performance of the predicate device. | Results demonstrate comparable mechanical properties to the predicate device (ROMEO® 2 Posterior Osteosynthesis System). |
| Bacterial Endotoxin Limit: Not explicitly stated as "acceptance criteria" but mentioned for pyrogenicity testing. The device must achieve an Endotoxin limit of 20 EU/device as specified in USP standard. | Bacterial endotoxin testing as specified in USP standard is used for pyrogenicity testing to achieve the Endotoxin limit of 20 EU / device. |
2. Sample size used for the test set and the data provenance
The document does not specify the exact sample sizes used for each of the mechanical tests (Static Axial Gripping, Static Axial Torque Gripping, Static Compression Bending, Static Torsion, and Dynamic Compression Bending). These are typically bench tests conducted on a sufficient number of device samples to ensure statistical validity and demonstrate equivalence to the predicate device.
Data provenance: The tests were conducted according to ASTM standards, which are internationally recognized. The data is from non-clinical testing performed by Spineart to support the 510(k) submission.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
Not applicable as this is not an AI/ML diagnostic device requiring expert interpretation for ground truth. The "ground truth" here is the objective measurement of mechanical properties against established ASTM standards and comparison to a legally marketed predicate device.
4. Adjudication method for the test set
Not applicable. Mechanical testing governed by ASTM standards uses objective measurements and predefined pass/fail criteria, often through comparison to a predicate device, rather than expert adjudication.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
Not applicable, as this is not an AI/ML device.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
Not applicable, as this is not an AI/ML device.
7. The type of ground truth used
For the mechanical tests, the ground truth is established by the specified ASTM standards (e.g., F1798, F1717) themselves, which define methodologies for measuring specific mechanical properties. The performance of the predicate device (ROMEO® 2 Posterior Osteosynthesis System) also serves as a benchmark for demonstrating substantial equivalence. For bacterial endotoxin, the USP standard defines the acceptable limit. A "cadaver lab trial" was also conducted, which provides real-world functional insights, but its "ground truth" would be observational and qualitative regarding surgical handling and fit rather than a strict quantitative measure against a "ground truth" in the diagnostic sense.
8. The sample size for the training set
Not applicable, as this is not an AI/ML device. There is no concept of a "training set" in the context of mechanical performance testing for this type of implant.
9. How the ground truth for the training set was established
Not applicable, as this is not an AI/ML device.
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February 5, 2020
Image /page/0/Picture/1 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.
Spineart Franck Pennesi Chief Technical Officer 3 Chemin du Pre-Fleuri 1228 Plan Les Quates Geneva Switzerland
Re: K193396
Trade/Device Name: PERLA® TL posterior osteosynthesis system Regulation Number: 21 CFR 888.3070 Regulation Name: Thoracolumbosacral Pedicle Screw System Regulatory Class: Class II Product Code: NKB Dated: December 3, 2019 Received: December 6, 2019
Dear Franck 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. 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 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for
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devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); 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 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 Advice (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
Ronald P. Jean, Ph.D. Director (Acting) 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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Indications for Use
510(k) Number (if known) K193396
Device Name PERLA® TL posterior osteosynthesis system
Indications for Use (Describe)
The PERLA® TL posterior osteosynthesis system is intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine: degenerative disc disease; spondylolisthesis; fracture; dislocation; scoliosis; kyphosis; spinal tumor; and failed previous fusion (pseudarthrosis). When used for posterior non-cervical pedicle screw fixation in pediatric patients, the PERLA® TL posterior osteosynthesis system is indicated as an adjunct to fusion to treat adolescent idiopathic scoliosis. The PERLA® TL posterior osteosynthesis system is intended to be used with autograft and/or allograft.
Pediatric pedicle screw fixation is limited to a posterior approach.
| 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)
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510(k) SUMMARY
| 510k | TRADITIONAL |
|---|---|
| Basis for submission | New devices |
| Submitted by | SPINEART3 Chemin du Pré Fleuri1228 PLAN LES OUATESGENEVA SWITZERLAND |
| Contacts | Franck PENNESI Chief Technical OfficerPhone: +41 22 570 1200 Fax: +41 22 594 8306Mail: fpennesi@spineart.comRegulatory contact: Dr Isabelle DRUBAIX (Idée Consulting) idrubaix@nordnet.fr |
| Date Prepared | February 5, 2020 |
| Common Name | Pedicle screw spinal system |
| Trade Name | PERLA® TL posterior osteosynthesis system |
| Classification Name | Thoracolumbosacral pedicle screw system |
| Class | II |
| Product Code | NKB; KWP |
| CFR section | 888.3070 |
| Device panel | ORTHOPEDIC |
| Legally marketed predicate devices | Primary predicate: ROMEO® 2 Posterior Osteosynthesis System manufactured bySpineart (K172101)Additional predicate: Mariner Outrigger Revision System manufactured bySeaSpine Orthopedics Corp. (K183639); Reform® Midline Cortical Screw Systemmanufactured by Precision Spine, Inc (K173130); Reform Pedicle Screw Systemmanufactured by Precision Spine, Inc (K151422) |
| Indications for use | The PERLA® TL posterior osteosynthesis system is intended to provideimmobilization and stabilization of spinal segments in skeletally mature patientsas an adjunct to fusion in the treatment of the following acute and chronicinstabilities or deformities of the thoracic, lumbar, and sacral spine: degenerativedisc disease; spondylolisthesis; fracture; dislocation; scoliosis; kyphosis; spinaltumor; and failed previous fusion (pseudarthrosis). When used for posterior non-cervical pedicle screw fixation in pediatric patients, the PERLA® TL posteriorosteosynthesis system is indicated as an adjunct to fusion to treat adolescentidiopathic scoliosis. The PERLA® TL posterior osteosynthesis system is intended tobe used with autograft and/or allograft.Pediatric pedicle screw fixation is limited to a posterior approach |
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| Description of thedevice | The PERLA® TL posterior osteosynthesis system consists of a range of screws, rodsset screws, hooks, rod connectors and cross-connectors. These connectingcomponents can be rigidly locked to the rod in a variety of configurations to beadapted for the individual case. The Perla®TL system is manufactured frommedical grade titanium alloy and medical grade cobalt chromium conformingrespectively to standards ASTM F136 and ASTM F1537.The PERLA® TL posterior osteosynthesis implants are delivered either non sterileor sterile (gamma sterilization) and supplied with dedicated surgical instruments(reusable - provided non-sterile except for the drill supplied as sterile or notsterile). Bacterial endotoxin testing as specified in USP standard is used forpyrogenicity testing to achieve the Endotoxin limit of 20 EU / device. | |
|---|---|---|
| Technologicalcharacteristicscompared to thepredicate devices | As was established in this submission, the PERLA® TL posterior osteosynthesissystem is substantially equivalent and has the same technological characteristicsto its predicate devices in areas including indications for use, function, materialcomposition, design, range of sizes and mechanical performance. | |
| Discussion of Testing | The following non-clinical tests were conducted on the PERLA® TL posteriorosteosynthesis system: Static Axial Gripping per ASTM F1798, Static Axial torquegripping per ASTM F1798, Static Compression bending per ASTM F1717, StaticTorsion per ASTM F1717 and Dynamic Compression bending per ASTM F1717.Results demonstrate comparable mechanical properties to the predicate deviceROMEO® 2 Posterior Osteosynthesis System manufactured by Spineart (K172101).Additionally, a cadaver lab trial was conducted. | |
| Conclusion | Based on the design features, technological characteristics, feature comparisons,indications for use, and non-clinical performance testing, the PERLA® TL posteriorosteosynthesis system has demonstrated substantial equivalence to the identifiedpredicate devices. |
§ 888.3070 Thoracolumbosacral pedicle screw system.
(a)
Identification. (1) Rigid pedicle screw systems are comprised of multiple components, made from a variety of materials that allow the surgeon to build an implant system to fit the patient's anatomical and physiological requirements. Such a spinal implant assembly consists of a combination of screws, longitudinal members (e.g., plates, rods including dual diameter rods, plate/rod combinations), transverse or cross connectors, and interconnection mechanisms (e.g., rod-to-rod connectors, offset connectors).(2) Semi-rigid systems are defined as systems that contain one or more of the following features (including but not limited to): Non-uniform longitudinal elements, or features that allow more motion or flexibility compared to rigid systems.
(b)
Classification. (1) Class II (special controls), when intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine: severe spondylolisthesis (grades 3 and 4) of the L5-S1 vertebra; degenerative spondylolisthesis with objective evidence of neurologic impairment; fracture; dislocation; scoliosis; kyphosis; spinal tumor; and failed previous fusion (pseudarthrosis). These pedicle screw spinal systems must comply with the following special controls:(i) Compliance with material standards;
(ii) Compliance with mechanical testing standards;
(iii) Compliance with biocompatibility standards; and
(iv) Labeling that contains these two statements in addition to other appropriate labeling information:
“Warning: The safety and effectiveness of pedicle screw spinal systems have been established only for spinal conditions with significant mechanical instability or deformity requiring fusion with instrumentation. These conditions are significant mechanical instability or deformity of the thoracic, lumbar, and sacral spine secondary to severe spondylolisthesis (grades 3 and 4) of the L5-S1 vertebra, degenerative spondylolisthesis with objective evidence of neurologic impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor, and failed previous fusion (pseudarthrosis). The safety and effectiveness of these devices for any other conditions are unknown.”
“Precaution: The implantation of pedicle screw spinal systems should be performed only by experienced spinal surgeons with specific training in the use of this pedicle screw spinal system because this is a technically demanding procedure presenting a risk of serious injury to the patient.”
(2) Class II (special controls), when a rigid pedicle screw system is intended to provide immobilization and stabilization of spinal segments in the thoracic, lumbar, and sacral spine as an adjunct to fusion in the treatment of degenerative disc disease and spondylolisthesis other than either severe spondylolisthesis (grades 3 and 4) at L5-S1 or degenerative spondylolisthesis with objective evidence of neurologic impairment. These pedicle screw systems must comply with the following special controls:
(i) The design characteristics of the device, including engineering schematics, must ensure that the geometry and material composition are consistent with the intended use.
(ii) Non-clinical performance testing must demonstrate the mechanical function and durability of the implant.
(iii) Device components must be demonstrated to be biocompatible.
(iv) Validation testing must demonstrate the cleanliness and sterility of, or the ability to clean and sterilize, the device components and device-specific instruments.
(v) Labeling must include the following:
(A) A clear description of the technological features of the device including identification of device materials and the principles of device operation;
(B) Intended use and indications for use, including levels of fixation;
(C) Identification of magnetic resonance (MR) compatibility status;
(D) Cleaning and sterilization instructions for devices and instruments that are provided non-sterile to the end user; and
(E) Detailed instructions of each surgical step, including device removal.
(3) Class II (special controls), when a semi-rigid system is intended to provide immobilization and stabilization of spinal segments in the thoracic, lumbar, and sacral spine as an adjunct to fusion for any indication. In addition to complying with the special controls in paragraphs (b)(2)(i) through (v) of this section, these pedicle screw systems must comply with the following special controls:
(i) Demonstration that clinical performance characteristics of the device support the intended use of the product, including assessment of fusion compared to a clinically acceptable fusion rate.
(ii) Semi-rigid systems marketed prior to the effective date of this reclassification must submit an amendment to their previously cleared premarket notification (510(k)) demonstrating compliance with the special controls in paragraphs (b)(2)(i) through (v) and paragraph (b)(3)(i) of this section.