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The OptiMesh Multiplanar Expandable Interbody Fusion System is indicated for use as an adjunct to fusion in an intervertebral body fusion at one level in the lumbar spine from L2 to S1 in skeletally mature patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history, physical examination, and radios. Eligible patients shall have undergone six (6) months of conservative (non-operative) care. The OptiMesh device with compatible allograft, or a bone void filler as cleared by FDA for use in intervertebral body fusion to facilitate fusion, is intended for use with supplemental posterior fixation systems intended for use in the lumbar spine.

AFT is intended for use as a bone void filler in the extremities, spine, intervertebral disc space, and pelvis for voids or gaps that are not intrinsic to the stability of the bony structure. AFT is indicated for use in the treatment of osseous defects caused by surgery or traumatic injury. When used in intervertebral body fusion procedures, AFT must be used on its own with an intervertebral body graff containment device cleared by FDA for use with a bone void filler.

The OptiMesh Multiplanar Expandable Interbody Fusion System is an intervertebral body graft containment device that is a non-rigid, implanted spinal device that is designed to contain bone graft within its internal cavity. The device is inserted into the intervertebral body space of the spine and is intended as an adjunct to intervertebral body fusion.

AFT Allograft Filler Tube is composed of human demineralized bone matrix, human nondemineralized bone, and sodium hyaluronate. All components of AFT are resorbable. AFT is aseptically processed and provided pre-loaded into a disposable delivery tube.

The provided text describes a 510(k) premarket notification for the "OptiMesh Multiplanar Expandable Interbody Fusion System" with the addition of "AFT Allograft Filler Tube" as a compatible allograft. It outlines the purpose of the submission, device descriptions, indications for use, technological characteristics, and non-clinical/clinical testing. However, the document does not provide specific acceptance criteria or detailed study results in the format requested.

The FDA 510(k) clearance process focuses on demonstrating "substantial equivalence" to a legally marketed predicate device, rather than proving a device meets specific, quantifiable acceptance criteria with a detailed study report. The non-clinical and clinical data presented here are used to support this claim of substantial equivalence.

Based on the provided text, I can infer some aspects and highlight what is not present:

Inferred Information:

• Acceptance Criteria (Implied): The implied acceptance criteria revolve around demonstrating that the OptiMesh device with AFT performs comparably to the predicate device and the reference devices in terms of mechanical performance and biological impact, without introducing new safety or effectiveness concerns. This means that:
  • Mechanical performance of OptiMesh + AFT should be "as intended" and comparable to the reference device and ISO 23089-2 data.
  • Biological impact of AFT should be comparable to the reference bone graft.
  • Biocompatibility, pyrogenicity/endotoxin, sterilization, packaging, and shelf-life should be acceptable and comparable.
  • The risk profile should not be altered, and new safety/effectiveness issues should not arise.
• Study Proving Acceptance Criteria: The study used to demonstrate this is primarily a critical engineering and clinical comparison to a bone graft used in a prospective, multi-center, non-randomized, FDA and IRB approved performance goal clinical investigation.

Information NOT present explicitly in the document:

• Specific quantifications of acceptance criteria.
• A table of acceptance criteria and reported device performance with numerical values.
• Sample sizes used for the test set (e.g., number of patients/data points in the clinical investigation for comparison).
• Data provenance (country of origin, retrospective/prospective for the comparison study). While it mentions a "prospective" clinical investigation for the reference bone graft, it doesn't specify if the comparison itself involved new prospective data or a retrospective analysis of the existing investigation's data.
• Number of experts used to establish ground truth or their qualifications.
• Adjudication method for the test set.
• MRMC comparative effectiveness study details (effect size, human reader improvement). This type of study is more common for diagnostic imaging AI than for interbody fusion systems.
• Standalone algorithm performance (algorithm only without human-in-the-loop). This is a physical device, so "standalone algorithm performance" is not applicable in the typical AI/software sense.
• Type of ground truth used (pathology, outcomes data, etc.) beyond "clinical data" and "performance goal clinical investigation."
• Sample size for the training set. There's no mention of a "training set" in the context of an AI/machine learning model. This submission is for a physical medical device.
• How the ground truth for the training set was established. (Not applicable for this type of device submission).

Given these limitations, here is the best possible answer based only on the provided text, heavily inferring the "acceptance criteria" based on the substantial equivalence claims:

1. Table of Acceptance Criteria and Reported Device Performance

2. Sample size used for the test set and data provenance:
* Sample Size: Not specified in the given text.
* Data Provenance: The clinical data for comparison comes from a "prospective, multi-center, non-randomized, FDA and IRB approved performance goal clinical investigation" involving a reference bone graft. The country of origin is not specified but it's an FDA-approved study, implying it was likely conducted in the US or under FDA oversight for data acceptability.

3. Number of experts used to establish the ground truth for the test set and their qualifications:
* Not specified. The clinical investigation mentioned for comparison would have medical professionals involved, but the text does not detail the "ground truth" establishment process by experts in the context of this submission.

4. Adjudication method for the test set:
* Not specified.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, and its effect size:
* No, an MRMC study is not mentioned. This type of study is typically for evaluating diagnostic imaging systems where human readers interpret medical images. This submission is for a physical interbody fusion system.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done:
* No, this concept is not applicable. The device is a physical medical implant, not an AI algorithm.

7. The type of ground truth used:
* The term "ground truth" is not explicitly used in the context of a dataset for algorithmic evaluation. However, for the clinical performance comparison, the "performance goal clinical investigation" likely established clinical outcomes (e.g., fusion rates, pain reduction, adverse events) as the de facto "truth" against which the subject device's performance (via comparison to a reference bone graft) was evaluated.

8. The sample size for the training set:
* Not applicable. This submission is for a physical medical device, not an AI/machine learning model that would require a training set.

9. How the ground truth for the training set was established:
* Not applicable, as there is no training set for an AI model.

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The OptiMesh Multiplanar Expandable Interbody Fusion System is indicated for use as an adjunct to fusion in an intervertebral body fusion at one level in the lumbar spine from L2 to S1 in skeletally mature patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history, physical examination, and radios. Eligible patients shall have undergone six (6) months of conservative (non-operative) care. The OptiMesh device with compatible allograft is intended for use with supplemental posterior fixation systems intended for use in the lumbar spine.

The OptiMesh Multiplanar Expandable Interbody Fusion System is an intervertebral body graft containment device that is a non-rigid, implanted spinal device designed to contain bone graft within its internal cavity. The device is inserted into the intervertebral body space of the spine and is intended as an adjunct to intervertebral body fusion.

The OptiMesh Lordotic device incorporates an asymmetrical dual chamber mesh with a larger chamber in the anterior portion of the disc space than in the posterior. Due to the asymmetry of the two mesh chambers when filled, the implant is designed to result in a lordotic shape.

The provided document is a 510(k) summary for the OptiMesh Multiplanar Expandable Interbody Fusion System. This document does not describe a study involving an AI/CADe device, human readers, or a test set with ground truth established by experts.

Instead, this document describes a medical device (an intervertebral body fusion system) and its mechanical and design properties. The non-clinical testing performed focuses on benchtop performance ASTM testing and risk assessment to demonstrate equivalence to a predicate device.

Therefore, I cannot provide the requested information, such as acceptance criteria for AI performance, sample sizes for test/training sets, expert qualifications, or adjudication methods, as these concepts are not applicable to the information presented in this 510(k) summary.

In summary, the provided document does not contain information about an AI/CADe device study to fulfill the prompt's requirements.

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Spineology Navigation Instruments are indicated for use during the preparation and placement of:

• Spineology's Fortress™, Threshold™, Threshold™ V2, and Palisade™ pedicle screws .
• Spineology's OptiMesh® Portal Assembly .

during spinal surgery to assist the surgeon in precisely locating anatomical structures in either open, minimally invasive, or percutaneous orthopedic procedures.

These instruments are designed for use with the Medtronic StealthStation® Spine System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the spine or pelvis, can be identified relative to images of the anatomy.

Spineology Navigation Instruments are non-sterile, reusable surgical instruments that are manufactured from stainless steel and operated manually.

Spineology Navigation Instruments for Pedicular Fixation include Awls, Bone Taps, Drills, and Screwdrivers. The navigable instruments are equipped with a dimensional feature that allows connection to Medtronic's NavLock Trackers. A Navigation Adapter is also available with dimensional features that allows the same instruments to Medtronic's SureTrak" II Universal Trackers. These instruments are compatible with Spineology's Fortress", Threshold" Threshold™ V2, and Palisade™ Pedicular Fixation Systems and Medtronic's StealthStation® S7 (v2.1.0) and S8 (v1.0.0) Spine System.

Spineology Navigation Instruments for Portal Placement include a Dilator, Portal, Tightener, Wrench, and a Portal Surrogate. The navigable instruments are equipped with dimensional features that allow connection to Medtronic's SureTrak II Universal Trackers. These instruments are compatible with Spineology's OptiMesh Expandable Interbody Fusion System for Access Portal Placement and Medtronic's StealthStation® S8 (v1.2.0) Spine System.

Spineology Navigation Instruments are intended to be used during the preparation and placement of spinal implants in optically navigated procedures.

This document (K213876) is a 510(k) premarket notification for Spineology Navigation Instruments. While it describes non-clinical testing performed to establish substantial equivalence to a predicate device, it does not detail a clinical study with an AI component or the specific acceptance criteria and performance data for an AI-powered device.

The document discusses "Spineology Navigation Instruments" which are physical surgical tools used for navigation during spinal surgery. The testing described (mating, registration, accuracy) relates to the mechanical and optical tracking performance of these instruments when used with Medtronic's StealthStation system, not the performance of an AI algorithm.

Therefore, I cannot extract the information required to answer your prompt because the provided input does not describe an AI/ML-based medical device.

**To answer your prompt, I would need a document describing the clearance/approval of an AI/ML device, ideally one that includes: **

• Specific performance metrics (e.g., sensitivity, specificity, AUC) for the AI model.
• Details about the datasets used (training and test sets, including provenance and size).
• Information on ground truth establishment (expert review, pathology, etc.).
• If applicable, details of MRMC studies or human-in-the-loop performance.

Without such information, any attempt to answer would be speculative and not based on the provided document.

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The Duo™ Expandable Interbody Fusion System is indicated for intervertebral body fusion at one level or two contiguous levels in the lumbar spine from L2 to L5 in patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level(s). DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies. These patients should be skeletally mature and have had six months of non-operative treatment. The Duo device is designed for use with autograft comprised of cancellous and/or corticocancellous bone graft as an adjunct to fusion and is intended for use with supplemental fixation systems cleared by the FDA for use in the lumbar spine.

The Duo Expandable Interbody Fusion System is an intervertebral implant designed to provide mechanical support of the intradiscal space as an adjunct to fusion. The device is made of PEEK-OPTIMA® LT-1, titanium alloy, polyethylene terephthalate (PET), and tantalum or OsteoSync™ titanium, titanium alloy, and PET. The Duo implant is available in varying lengths, widths, heights, lordotic angles and is provided sterile. The implant is designed with a porous central cavity for graft containment, a rounded nose to aid in implant insertion, and rigid teeth to resist migration.

This document (K210155) is a 510(k) premarket notification for a medical device called the "Duo™ Expandable Interbody Fusion System," specifically a line extension of implants and implant trials. It describes the device, its intended use, and non-clinical testing performed to demonstrate substantial equivalence to legally marketed predicate devices.

However, the provided text does not contain any information regarding acceptance criteria, device performance results against those criteria, sample sizes for test or training sets, ground truth establishment, expert qualifications, adjudication methods, or multi-reader multi-case studies generally associated with AI/ML-based medical devices or diagnostic tools.

The document primarily focuses on demonstrating mechanical and performance equivalence through benchtop ASTM testing for an intervertebral body fusion device, which is a physical implant, not a software or AI/ML diagnostic tool. Therefore, the requested information about AI/ML performance metrics, expert reviews, and data provenance typical for software validation studies is not applicable to this submission.

Based on the provided text, I cannot complete the table or answer the specific questions about acceptance criteria for an AI/ML device, as this device is a physical implant and the testing described is related to its mechanical and material properties.

If there's an assumption that this is an AI/ML device based on the prompt structure, that assumption is incorrect when applied to the provided content. The document describes a traditional medical device submission for a spinal implant.

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The Duo™ Lumbar Interbody Fusion Device is indicated for intervertebral body fusion at one level or two contiguous levels in the lumbar spine from L2 to L5 in patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level(s). DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies. These patients should be skeletally mature and have had six months of non-operative treatment. The Duo device is designed for use with autograft comprised of cancellous and/or corticocancellous bone graft as an adjunct to fusion and is intended for use with supplemental fixation systems cleared by the FDA for use in the lumbar spine.

The Duo Lumbar Interbody Fusion Device is an intervertebral implant designed to provide mechanical support of the intradiscal space as an adjunct to fusion. The device is made of PEEK-OPTIMA® LT-1, titanium alloy, polyethylene terephthalate (PET), and tantalum. The Duo implant is available in varying lengths and heights with two lordotic configurations and is provided sterile. The device is designed with a porous central cavity for graft containment, a rounded nose to aid implant insertion, and ridged teeth to resist migration.

The provided text is a 510(k) Summary for a medical device (Duo Lumbar Interbody Fusion Device) and does not contain information about acceptance criteria, study methodologies, or performance metrics typically associated with AI/ML-based medical devices. This document is related to a traditional medical device and focuses on demonstrating substantial equivalence to a predicate device based on design, materials, and intended use, rather than algorithmic performance.

Therefore, I cannot extract the requested information regarding acceptance criteria and a study proving a device meets them for an AI/ML product from the given text. The provided document concerns a spinal implant and its surgical instruments, not an AI/ML device.

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The Duo™ Lumbar Interbody Fusion Device is indicated for intervertebral body fusion at one level or two contiguous levels in the lumbar spine from L2 to L5 in patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level(s). DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies. These patients should be skeletally mature and six months of non-operative treatment. The Duo device is designed for use with autograft comprised of cancellous and/or corticocancellous bone graft as an adjunct to fusion and is intended for use with supplemental fixation systems cleared by the FDA for use in the lumbar spine.

The Duo™ Lumbar Interbody Fusion Device is an intervertebral implant designed to provide mechanical support of the intradiscal space as an adjunct to fusion. The device is made of PEEK-OPTIMA® LT-1, titanium alloy, polyethylene terephthalate (PET), and tantalum. The Duo implant is available in varying lengths and heights with two lordotic configurations, and is provided sterile. The device is designed with a porous central cavity for graft containment, rounded nose to aid implant insertion, and ridged teeth to resist migration.

I am sorry, but the provided text is a 510(k) Premarket Notification from the FDA for a medical device called the "Duo™ Lumbar Interbody Fusion Device." It describes the device, its intended use, indications for use, and a comparison to a predicate device. It also mentions some non-clinical testing for surgical instrumentation modifications.

However, the document does NOT contain any information about acceptance criteria for the device's performance, nor does it describe any study that proves the device meets such criteria.

Therefore, I cannot provide the requested information about:

1. A table of acceptance criteria and reported device performance.
2. Sample size used for the test set or data provenance.
3. Number of experts or their qualifications for ground truth.
4. Adjudication method.
5. Multi-reader multi-case (MRMC) comparative effectiveness study results.
6. Standalone algorithm performance.
7. Type of ground truth used.
8. Sample size for the training set.
9. How ground truth for the training set was established.

This document focuses on regulatory approval based on substantial equivalence to a predicate device, rather than detailed performance study results that would typically be found in a clinical trial report or a more extensive technical file.

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Spineology Navigation Instruments are intended to be used during the preparation and placement of Spineology's Fortress, Threshold, Threshold V2, and Palisade pedicle screws during spinal surgery to assist the surgeon in precisely locating anatomical structures in either open or minimally invasive procedures. These instruments are designed for use with the Medtronic StealthStation® System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as a skull, long bone, or vertebra, can be identified relative to a CT- or MR-based model, fluoroscopic images, or digitalized landmarks of the anatomy.

Spineology Navigation Instruments are non-sterile, reusable instruments; including awls, bone taps, drills, and screwdrivers that are operated manually. These instruments are manufactured from stainless steel in accordance with ASTM F899 and are intended to be used within the context and limitations of the indications for use for Spineology's FDA-cleared Fortress™, Threshold™, Threshold™ V2, and Palisade™ Pedicular Fixation Systems and the Medtronic Synergy Experience StealthStation® System S7 (v2.1.0).

The provided text describes the 510(k) premarket notification for Spineology Navigation Instruments. This document demonstrates the substantial equivalence of the new instruments to a legally marketed predicate device, rather than proving a device meets specific clinical acceptance criteria through a standalone study.

Therefore, many of the requested details regarding acceptance criteria, device performance, sample size, ground truth, and expert involvement are not applicable as this is a regulatory submission for substantial equivalence based on technological characteristics and non-clinical testing, not a clinical effectiveness study.

Here's what can be extracted from the provided text based on your request:

Acceptance Criteria and Reported Device Performance

The document does not explicitly state numerical acceptance criteria in the format of a typical clinical study. Instead, the "acceptance criteria" are implied by demonstrating substantial equivalence to a predicate device. The performance is assessed through non-clinical testing focused on compatibility and accuracy within the context of the Medtronic StealthStation System.

Study Details

1. Sample size used for the test set and the data provenance:

   • Test Set Sample Size: Not specified in terms of numerical count for instruments or specific test scenarios. The non-clinical testing generally refers to "Spineology Navigation Instruments."
   • Data Provenance: The "Non-Clinical Testing" section describes in-house design verification activities performed by Spineology Inc. No specific country of origin for data is mentioned, and the testing is described as internal verification rather than external data collection. The tests are retrospective in the sense that they are internal design verification activities.

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

   • This information is not applicable. The "ground truth" for non-clinical engineering tests (like instrument mating, registration, and accuracy) is typically established by engineering specifications, validated measurement systems, and comparison to known good standards or predicate device performance, not by clinical experts establishing ground truth in the way it's done for diagnostic AI. The document does not mention external experts or their qualifications for establishing ground truth in these non-clinical tests.

3. Adjudication method (e.g., 2+1, 3+1, none) for the test set:

   • This information is not applicable. Adjudication methods like 2+1 or 3+1 are typically used in clinical studies involving human interpretation or subjective assessments. The non-clinical tests described (instrument mating, registration, accuracy comparison) would involve objective measurements and comparisons against established metrics or predicate device performance, not clinical adjudication.

4. 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:

   • No, an MRMC comparative effectiveness study was not done. This document pertains to the clearance of surgical navigation instruments, not an AI-assisted diagnostic or interpretative device. Therefore, there is no mention of human readers, AI assistance, or effect sizes in this context.

5. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:

   • This information is not applicable. The device (Spineology Navigation Instruments) is a physical surgical instrument intended for use with the Medtronic StealthStation System and by a surgeon (human-in-the-loop). It is not an algorithm that operates in a standalone capacity.

6. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

   • For the non-clinical tests described, the "ground truth" would be based on:
     • Engineering Specifications: For instrument mating and registration, the "ground truth" is that the instruments must correctly connect and register according to pre-defined engineering standards for the Medtronic StealthStation System.
     • Predicate Device Performance: For accuracy, the "ground truth" is the established accuracy of the equivalent Medtronic Navigation Instruments, to which the new Spineology instruments were compared.
   • This is not clinical ground truth like pathology or outcomes data.

7. The sample size for the training set:

   • This information is not applicable. There is no mention of a "training set" because this device is a physical instrument, not an AI or machine learning model that requires training data.

8. How the ground truth for the training set was established:

   • This information is not applicable as there is no training set mentioned or implied for this device.

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The standard and oblique Rampart One devices are integrated intervertebral body fusion devices indicated for intervertebral body fusion at one level or two contiguous levels in the lumbar spine from L2 to S1 in patients with degenerative disc disease (DDD) with up to Grade I spondylolisthesis at the involved level(s). DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies. These patients should be skeletally mature and had six months non-operative treatment. The standard and oblique Rampart One devices are designed for use with autograft and/or allograft comprised of cancellous bone graft.

The standard Rampart One device may be used with or without supplemental fixation systems cleared by FDA for use in the lumbar spine. When used without supplemental fixation, the standard Rampart One device must be used with four (4) screws.

The oblique Rampart One device must be used with supplemental fixation systems cleared by FDA for use in the lumbar spine.

Rampart One implants are intervertebral body fusion devices for use with bone graft in the intervertebral disc space to stabilize spinal segments as an adjunct to fusion. These devices are manufactured from PEEK-OPTIMA HA Enhanced (spacer), titanium alloy (face plate), and tantalum (radiopaque markers) materials. Rampart One devices incorporate integrated fixation in the form of titanium alloy screws. Rampart One devices are provided in standard and oblique configurations. The standard device accommodates four screws and the oblique device accommodates two screws. In each device, the screws are inserted through the anteriorly-located face plate into the adjacent vertebral bodies. Rampart One devices are provided in various heights and lordotic angles and contain a hollow core to receive autograft and/or allograft comprised of cancellous and/or corticocancellous bone graft. Placement is achieved with an insertion instrument that allows for manipulation of the implant in the intervertebral disc space.

Regarding the Rampart™ One Lumbar Interbody Fusion Device and its K180002 submission for expanded indications of use, the document states that no new performance or clinical testing was performed or required. Therefore, there are no specific new acceptance criteria or studies associated with this particular submission that prove new performance.

The document instead refers to previously conducted performance testing for the Rampart One device and a review of published clinical data for similar stand-alone devices.

Here's a breakdown based on the provided text, focusing on what is mentioned or not mentioned:

1. Table of Acceptance Criteria and Reported Device Performance

Since new performance testing was not conducted for this specific submission, there isn't a table of new acceptance criteria and device performance. The document states that the initial performance testing for the Rampart One device remains valid. That initial testing established conformance to the following standards:

Note: The specific quantitative performance metrics (e.g., specific load values, displacement limits) for "conformed" are not provided in this summary but would have been part of the original K163670 submission's testing report.

2. Sample Size Used for the Test Set and Data Provenance

• For Performance Testing: The sample sizes used for the initial performance testing (referenced but not detailed here) are not specified in this document. These would have been documented in the original K163670 submission.
• For Clinical Data (Review): The document mentions a "review of published clinical data," which implies data collected retrospectively or prospectively from various studies. No specific sample size or data provenance (e.g., country of origin) is given for this review, as it refers to a compilation of existing literature rather than a new, specific clinical study associated with this submission.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications

This information is not applicable to this submission, as no new clinical test set was created or evaluated in a way that required an independent expert panel for ground truth establishment. The clinical evaluation relied on a review of existing published literature.

4. Adjudication Method for the Test Set

This information is not applicable, as no new clinical test set requiring adjudication was performed for this submission.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No MRMC comparative effectiveness study was done for this submission. The submission states that "clinical testing was not required or performed to support substantial equivalence."

6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study

This question is not applicable as the device is a physical medical implant, not an algorithm or AI software, and therefore "standalone performance" in that context does not apply.

7. Type of Ground Truth Used

• For Performance Testing: The ground truth for the engineering performance tests (e.g., compression, pullout) is the physical properties and mechanical behavior of the device under specified testing conditions, as measured against the limits set by the ASTM standards.
• For Clinical Data Review: The "ground truth" for the clinical evaluation was derived from published clinical outcomes related to similar stand-alone anterior lumbar intervertebral body fusion devices with integrated fixation. This essentially means the consensus findings and results reported in established medical literature.

8. Sample Size for the Training Set

This is not applicable as the device is a physical implant and does not involve a "training set" in the context of an algorithm or AI model.

9. How the Ground Truth for the Training Set Was Established

This is not applicable as the device is a physical implant and does not involve a "training set" in the context of an algorithm or AI model.

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Spineology Navigation Instruments are intended to be used during the preparation and placement of Spineology's Fortress, Threshold V2, and Palisade pedicle screws during spinal surgery to assist the surgeon in precisely locating anatomical structures in either open or minimally invasive procedures. These instruments are designed for use with the Medtronic StealthStation® System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as a skull, long bone, or vertebra, can be identified relative to a CT- or MR-based model, fluoroscopic images, or digitalized landmarks of the anatomy.

Spineology Navigation Instruments are non-sterile, reusable instruments; including awls, bone taps, drills, and screwdrivers that are operated manually. These instruments are manufactured from stainless steel in accordance with ASTM F899 and are intended to be used within the context and limitations of the indications for use for Spineology's FDA-cleared Fortress, Threshold V2, and Palisade Pedicular Fixation Systems and the Medtronic Synergy Experience StealthStation System 57 (v2.1.0).

The provided text is a 510(k) Summary for the Spineology Navigation Instruments. While it describes the device, its intended use, and indicates that design verification testing was conducted, it does not provide specific acceptance criteria or detailed results of a study that proves the device meets those criteria.

Here's an analysis of the information available and what is missing:

1. A table of acceptance criteria and the reported device performance

• Missing: The document states that "Design verification testing, including mating, registration, and accuracy, was conducted to ensure that Spineology Navigation Instruments are safe and effective for their intended use..." However, it does not list the specific acceptance criteria for "mating," "registration," or "accuracy." It also does not report the performance results (e.g., specific accuracy metrics, successful mating rates, or registration success rates) for the Spineology Navigation Instruments.

2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective)

• Missing: The document mentions "testing" but does not specify any sample sizes for the test sets used for mating, registration, or accuracy testing. It also does not provide any information regarding data provenance (e.g., country of origin, retrospective/prospective). This type of device typically uses in-vitro or bench testing, not patient data in the same way an AI/software device would.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g., radiologist with 10 years of experience)

• Not Applicable/Missing: For a stereotaxic instrument, "ground truth" is typically established through precise engineering measurements and metrology, not expert review of images or clinical outcomes in the same way an AI diagnostic device would. If the "accuracy testing" involved human assessment of alignment, the number and qualifications of those individuals are not mentioned.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set

• Not Applicable/Missing: Adjudication methods like 2+1 or 3+1 are typically used in clinical studies involving human interpretation or subjective assessments, often for establishing ground truth. For this type of device, which involves mechanical and software-based accuracy, "adjudication" in this sense is not relevant.

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: This is a physical navigation instrument intended for use with a pre-existing medical device (Medtronic StealthStation® System), not an AI algorithm designed to assist human readers (e.g., radiologists interpreting images). Therefore, an MRMC study related to AI assistance is not relevant to this submission.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done

• Not Applicable: This is a physical instrument. While the StealthStation® System has an algorithm component, the Spineology Instruments themselves are not standalone algorithms. The testing here focuses on the instruments' compatibility and physical performance when used with the StealthStation.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

• Not explicitly stated/Implied by Device Type: For "accuracy testing" of navigation instruments, the ground truth would typically be established through highly precise mechanical measurements against known reference points, using CMMs (Coordinate Measuring Machines) or similar metrology equipment, rather than clinical ground truth like pathology or outcomes data. The document does not explicitly state the method for establishing this ground truth.

8. The sample size for the training set

• Not Applicable: This is a medical device, not a machine learning or AI model that requires a training set.

9. How the ground truth for the training set was established

• Not Applicable: As above, this is not an AI/ML device requiring a training set.

Summary of what is present in the document regarding the study:

• Study Description: Design verification testing was performed, including "mating, registration, and accuracy."
• Purpose of Study: To ensure the instruments are safe and effective, functional, compatible with the Medtronic StealthStation®, and substantially equivalent to the predicate device.
• Comparison: Accuracy testing included a "side-by-side comparison of Spineology Navigation Instruments to the predicate device."

In conclusion, while the document confirms that testing was performed, it lacks the detailed information requested regarding specific acceptance criteria, performance results, sample sizes, and detailed methodology for establishing ground truth, which are typically found in more comprehensive study reports or test protocols. This 510(k) Summary focuses on demonstrating substantial equivalence primarily through design and technological characteristics and high-level summaries of testing, rather than an in-depth clinical or performance study report.

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Spineology Pedicular Fixation Systems are intended for posterior, non-cervical fixation as an adjunct to fusion in skeletally mature patients for the following indications: degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies) spondylolisthesis; trauma (i.e., fracture or dislocation); spinal stenosis; curvatures (i.e., scoliosis, kyphosis and/or lordosis); turnor; pseudoarthrosis; and/ or failed previous fusion.

Spineology Fortress™, Threshold™ V2, and Palisade™ Pedicular Fixation Systems consist of screws (titanium alloy), curved and straight rods (see table below for diameters and material), and ConneX™ Connector (see table below for configurations and materials) devices to allow the surgeon to build an implant system to fit the patient's anatomical and physiological requirements. All screws are available with or without a hydroxyapatite coating. These systems are intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine. The screws can be placed in the pedicles in a variety of trajectories ranging from the standard anatomic transpedicular path projected medially toward the ventral vertebral body, to a caudocephalad path sagittally and a laterally directed path in the transverse plane.

Spineology Connex Cross Connector devices are transversely-placed titanium alloy implants that are intended to connect the rod on one side of a spinal construct to the rod on the other side. These devices are manufactured from titanium alloy and are adjustable to allow the surgeon to build an implant system to fit the patient's anatomical and physiological requirements. Connextor devices are intended to provide immobilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine.

Spineology ConneX Rod Connector devices are titanium alloy implants that are intended to connect two rods in a spinal construct. These devices are manufactured from titanium alloy and the components allow the surgeon to build an implant system to fit the patient's anatomical and physiological requirements. Connex Rod Connector devices are intended to provide immobilization and stabilization of spinal segments in skeletally mature patients as an adjunct to fusion in the treatment of acute and chronic instabilities or deformities of the thoracic, lumbar, and sacral spine.

The Spineology Power Adapter is an instrument accessory intended to facilitate the preparation and placement of pedicle screws using powered instrumentation as an optional alternative to the existing manual technique. The Power Adapter is intended for exclusive use with Spineology Fortress, Threshold, Threshold V2, and Palisade System surgical instruments. The Power Adapter serves as a mechanical interface between the power driver and surgical instruments. When the Power Adapter is attached, the power driver provides appropriate power to rotate the surgical instrument for preparation and placement of pedicle screws.

The provided text describes modifications to existing pedicular fixation systems and a new power adapter for surgical instrumentation, rather than a standalone AI device with specific acceptance criteria and a study to prove its performance in the typical sense of AI/ML evaluation (e.g., sensitivity, specificity, AUC, etc.).

Therefore, the requested information elements related to AI/ML device evaluation metrics, expert ground truth development, MRMC studies, or training sets are not applicable or derivable from this submission, as the submission pertains to a conventional medical device and not an AI/ML-driven diagnostic or prognostic tool.

However, I can extract the non-clinical testing performed to establish substantial equivalence for the modifications and the new Power Adapter, which functionally serve as "acceptance criteria" and the "study" demonstrating they meet those criteria within the context of a 510(k) submission for a non-AI device.

1. Table of Acceptance Criteria and Reported Device Performance

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

• Sample Size: Not explicitly stated in terms of number of devices tested for each test. The tests are described by type (e.g., ASTM F1798, ASTM F1717, simulated clinical use for the Power Adapter). For screw modifications, "a thorough review, risk assessment, and comparison" was performed.
• Data Provenance: Not specified. Standard mechanical and performance tests (e.g., ASTM standards) are typically conducted in a laboratory setting. The "simulated use environment" for the Power Adapter implies lab-based testing rather than clinical data. No country of origin for data is mentioned. The studies appear to be laboratory-based and prospective in the sense that they were conducted for this specific submission, but not prospective clinical trials.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

• Not applicable. This is a conventional medical device submission, not an AI/ML device relying on expert-annotated "ground truth" for performance evaluation. The "ground truth" is typically defined by engineering specifications, material properties, and adherence to performance standards.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

• Not applicable. This is not an AI/ML device requiring human adjudication of results from a diagnostic or prognostic algorithm.

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. This is not an AI-assisted device.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

• Not applicable. This is a physical medical device and an instrument accessory, not an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

• For the rods: Engineering specifications, material properties, and established mechanical testing standards (ASTM F1798, ASTM F1717).
• For the pedicle screws: Comparison to the primary design characteristics, materials, manufacturing processes, existing mechanical performance testing, and product experience of already cleared equivalent devices.
• For the Power Adapter: Functional performance in simulated use conditions, adherence to mechanical and functional specifications (e.g., screw loading, screw insertion, compatibility).

8. The sample size for the training set

• Not applicable. There is no AI/ML component, and therefore no "training set."

9. How the ground truth for the training set was established

• Not applicable. Since there is no training set, there is no ground truth established for it.

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