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The 4CIS® Chiron Spinal Fixation 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:

1. Degenerative disc disease (defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies)
2. Spondylolisthesis
3. Trauma (i.e., fracture or dislocation)
4. Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis)
5. Tumor
6. Stenosis
7. Failed previous fusion (pseudoarthrosis).

The 4CIS® Chiron Spinal Fixation System is a top-loading posterior spinal fixation system which consists of pedicle screws, rods, nuts, transverse (cross) link and associated instruments. Rigid fixation is provided by pedicle screws inserted into the vertebral body through pedicle of the lumbar spine via posterior approach. This system will allow surgeons to build a spinal implant construct to stabilize and promote spinal fusion through open surgery or minimally invasive surgery. Implant components can be rigidly locked into a variety of different configurations to suit the individual pathology and anatomical conditions of the mature patient. The implant components are supplied non-sterile single use and are fabricated from titanium alloy (Ti-6A1-4V ELI) that conforms to ASTM F 136 and Cobalt Alloy (Co-28Cr-6Mo) per ASTM F1537. Also, instruments are available for the application and removal of the Spinal Fixation System.

This document is a 510(k) premarket notification for the "4CIS® Chiron Spinal Fixation System." It details the device's characteristics, indications for use, and a comparison to predicate devices, along with performance data. However, it does not include detailed acceptance criteria or extensive study results that would typically be found in a clinical trial report.

Here's an analysis of the provided text in relation to your questions:

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

The document provides summary statements about performance data but does not explicitly list acceptance criteria or specific numerical results in a table format. It states:

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

The document mentions "Mechanical testing was performed," but does not explicitly state the sample size (e.g., number of spinal fixation systems tested) for this testing. It also doesn't specify the country of origin for the data or whether it was retrospective or prospective. Given it's mechanical testing of a physical device, it's typically performed in a lab setting rather than involving human subjects or real-world data in the same way clinical studies do.

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)

This question is not applicable to the type of data presented. The "ground truth" for mechanical testing is based on the physical properties and performance of the device under defined conditions, typically measured by engineering standards and equipment, not by expert medical interpretation.

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

This question is not applicable. Adjudication methods like 2+1 or 3+1 are used in clinical studies where expert consensus is needed to establish ground truth for diagnoses or interpretations. Mechanical testing uses objective measurements against predefined standards.

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

No such study was mentioned or performed. This document is for a spinal fixation system, which is a physical implant, not an AI software or a device that assists human readers/diagnosticians.

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

This question is not applicable, as this is a physical medical device, not a software algorithm.

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

The ground truth for the performance of the 4CIS® Chiron Spinal Fixation System, as described, is based on mechanical testing results against established ASTM standards (ASTM F1717 and ASTM F1798) and comparison to the performance of predicate devices. This is an engineering-based ground truth.

8. The sample size for the training set

This question is not applicable. The device is a physical implant. The concept of a "training set" is relevant for machine learning models, not for mechanical testing of a spinal fixation system.

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

This question is not applicable, as there is no training set for this type of device and testing.

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The 4CIS® Chiron spinal fixation 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:

1. Degenerative disc disease (defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies):
2. Spondylolisthesis;
3. Trauma (i.e., fracture or dislocation);
4. Deformities or curvatures (i.e., scoliosis, kyphosis, and/or lordosis);
5. Tumor;
6. Stenosis:
7. Failed previous fusion (pseudoarthrosis).

The Spinal Fixation System is a top-loading posterior spinal fixation system which consists of pedicle screws, rods, nuts, transverse (cross) link and associated instruments. Rigid fixation is provided by pedicle screws inserted into the vertebral body through pedicle of the lumbar spine via posterior approach. This system will allow surgeons to build a spinal implant construct to stabilize and promote spinal fusion through open surgery or minimally invasive surgery. Implant components can be rigidly locked into a variety of different configurations to suit the individual pathology and anatomical conditions of the mature patient. The implant components are supplied non-sterile single use and are fabricated from titanium alloy (Ti-6A1-4V ELI) that conforms to ASTM F136 and Cobalt Alloy (Co-28Cr-6Mo) per ASTM F1537. Also, Specialized instruments are available for the application and removal of the Spinal Fixation System.

The provided document is a 510(k) Premarket Notification for a spinal fixation system (4CIS® Chiron Spinal Fixation System). It focuses on demonstrating substantial equivalence to previously marketed devices through mechanical testing and comparison of design features and indications for use.

Crucially, this document does NOT contain information about an AI/ML-driven medical device or any study involving human readers, ground truth establishment by experts, or performance metrics like sensitivity, specificity, or AUC.

Therefore, I cannot provide the requested information regarding acceptance criteria and a study that proves a device meets them for an AI/ML product based on this document. The document describes a traditional medical device (implantable hardware) and its clearance pathway, which relies on engineering and mechanical testing, not software performance studies.

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The PASS LP Spinal System includes a pedicle system 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 of thoracic, lumbar, and sacral spine: fracture, dislocation, failed previous fusion (pseudoarthrosis), spinal stenosis, degenerative spondylolisthesis with objective evidence of neurological impairment, spinal deformations such as scoliosis or kyphosis and loss of stability due to tumors.

The PASS LP Spinal System is also indicated for pedicle screw fixation for the treatment of severe spondylolisthesis (Grade 3 and 4) of the L5-S1 vertebrae in skeletally mature patients receiving fusion by autogenous bone graft having implants attached to the lumbar and sacral spine (13 to sacrum) with removal of the implants after the attainment of a solid fusion.

The PASS LP also includes hooks, rods and sacral/iliac screws indicated for degenerative disc disease (ddd) 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, deformities or curvatures (i.e., scoliosis, and/or lordosis), tumor, pseudoarthrosis and failed previous fusion.

The Medicrea PASS LP Spinal System consists of pedicle screws, hooks, sacral plates, clamps, rods, nuts, rod plates and crosslink members. It can be used for single or multiple level fixations. Components are manufactured from titanium alloy (Ti-6Al-4V ELI) that conforms to ASTM F136

Here's an analysis based on the provided text:

This document is a 510(k) summary for a medical device called the PASS LP Spinal System. A 510(k) submission is for demonstrating substantial equivalence to a predicate device, not typically for reporting on detailed acceptance criteria and clinical performance studies of the type described in the prompt. The provided text primarily focuses on comparing the new device to existing legally marketed predicate devices and outlining the mechanical testing performed.

Therefore, the requested information about acceptance criteria and studies demonstrating that the device (i.e., AI/software) meets these criteria cannot be fully extracted from this document, as it pertains to a mechanical spinal implant system, not a software device.

However, I can extract what is available regarding the mechanical aspects of the device and structure it to the best of my ability according to your request, while highlighting the absence of information relevant to software performance studies.

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

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

• Sample Size: Not specified for the mechanical tests.
• Data Provenance: Not specified, but generally, mechanical testing is performed in a lab setting, not on patient data.

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 information is for medical device software performance evaluations involving expert interpretation. The provided document describes mechanical testing of a spinal implant.

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

• Not applicable. This information is for medical device software performance evaluations involving expert interpretation. The provided document describes mechanical testing of a spinal implant.

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

• No MRMC study was done. This device is a mechanical spinal implant, not an AI-assisted diagnostic or therapeutic tool.

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

• Not applicable. This device is a mechanical spinal implant, not an algorithm.

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

• For the mechanical performance, the "ground truth" would be the standards set by ASTM (e.g., F1717, F1798) for mechanical properties and the ASTM F136 standard for titanium alloy material properties. The device's performance is compared against these engineering standards and to the performance of predicate devices.

8. The sample size for the training set

• Not applicable. This document describes a mechanical implant, not a machine learning model that requires a training set.

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

• Not applicable. As above, this is for a mechanical implant, not a machine learning model.

Summary of Device and Study:

The device is the PASS LP Spinal System, an orthopedic implant designed for spinal fixation. This 510(k) submission is for an "Additional components" to the already cleared system, specifically noting the "PASS MIS" product as having the same material and geometry as existing PASS LP devices, but with restrained indications for use.

The "study" or performance data presented focuses on mechanical testing:

• Tests Performed: Static torsion, static and dynamic compression bending (per ASTM F1717), static axial sliding, static torsion, and dynamic flexion/extension (per ASTM F1798).
• Purpose of Testing: To demonstrate that the additional components are "as mechanically sound as other devices commercially available."
• Material Conformance: The device is manufactured from titanium alloy (Ti-6Al-4V ELI) that conforms to ASTM F136.

The document does not contain information related to AI/software performance studies, human reader performance, or clinical efficacy trials beyond the statement that mechanical tests were performed to demonstrate mechanical soundness compared to predicates. The 510(k) clearance (K112493) confirms substantial equivalence to the predicate devices based on the information provided, including the mechanical testing.

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