BLACKSTONE III DEGREE ANTERIOR CERVICAL PLATING SYSTEM (PLATE WASHER)

K020620 · Blackstone Medical, Inc. · KWQ · May 23, 2002 · Orthopedic

Device Facts

• Record ID: K020620
• Device Name: BLACKSTONE III DEGREE ANTERIOR CERVICAL PLATING SYSTEM (PLATE WASHER)
• Applicant: Blackstone Medical, Inc.
• Product Code: KWQ · Orthopedic
• Decision Date: May 23, 2002
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3060
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Blackstone™ III° Anterior Cervical Plating System is intended for anterior fixation to the cervical spine from C2 to C7. The specific clinical indications include: - a) degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies); - b) spondylolisthesis; - c) fracture; - d) spinal stenosis; - e) deformities (i.e., scoliosis, kyphosis, and/or lordosis); - f) tumor: - g) pseudarthrosis; - h) revision of previous surgery

Device Story

Titanium alloy (6AL-4V ELI) cover plate component for Blackstone™ III Anterior Cervical Plating System; used by surgeons in clinical/OR settings to stabilize cervical spine during bone graft fusion; provides anterior fixation; non-sterile, single-use implant; enhances construct stability.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Material: Titanium alloy (6AL-4V ELI) per ASTM F136. Form factor: Cervical plate component. Energy source: None (mechanical implant). Sterilization: Non-sterile.

Indications for Use

Indicated for patients requiring anterior cervical spine fixation (C2-C7) for degenerative disc disease, spondylolisthesis, fracture, spinal stenosis, deformities (scoliosis, kyphosis, lordosis), tumor, pseudarthrosis, or revision surgery.

Regulatory Classification

Identification

A spinal intervertebral body fixation orthosis is a device intended to be implanted made of titanium. It consists of various vertebral plates that are punched into each of a series of vertebral bodies. An eye-type screw is inserted in a hole in the center of each of the plates. A braided cable is threaded through each eye-type screw. The cable is tightened with a tension device and it is fastened or crimped at each eye-type screw. The device is used to apply force to a series of vertebrae to correct “sway back,” scoliosis (lateral curvature of the spine), or other conditions.

Predicate Devices

• Blackstone™ III° Anterior Cervical Plating System (K012184)
• Blackstone™ Anterior Cervical Plate System (K974885)

Submission Summary (Full Text)

{0}------------------------------------------------

020620 p 1/2

# MAY 2 3 2002

Premarket Notification Blackstone Medical, Inc. Blackstone™ III Anterior Cervical Plating System Cover Plate (System Addition)

### 510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

| Name of Firm: | Blackstone Medical, Inc.<br>90 Brookdale Drive<br>Springfield, MA 01104 |
|------------------------------------------|-------------------------------------------------------------------------|
| 510(k) Contact: | Alan Lombardo<br>Director of Engineering |
| Trade Name: | Blackstone™ III° Anterior Cervical Plating System |
| Common Name: | Cervical Plating Instrumentation |
| Device Product Code<br>& Classification: | KWQ 888.3060 - Spinal Intervertebral Body Fixation<br>Orthosis |

### Substantially Equivalent Devices:

Blackstone™ III° Anterior Cervical Plating System (K012184) Blackstone™ Anterior Cervical Plate System (K974885)

### Device Description:

The Cover Plate addition for the Blackstone™ III° Anterior Cervical Plating System is a titanium alloy (6AL-4V ELI, per ASTM F136) device which is a non-sterile, single use component. When used with the Blackstone™ III° Anterior Cervical Plating System a surgeon can build an anterior cervical implant construct. The system's design is intended to stabilize the cervical spinal operative site during the fusion process of a bone graft in the disc space.

### Intended Use / Indications for Use:

Blackstone™ III° Anterior Cervical Plating System is intended for anterior fixation to the cervical spine from C2 to C7. The specific clinical indications include:

- a) degenerative disc disease (as defined as back pain of discogenic origin with degenerative disc confirmed by patient history and radiographic studies);
- b) spondylolisthesis;
- c) fracture;
- d) spinal stenosis;
- e) deformities (i.e., scoliosis, kyphosis, and/or lordosis);
- f) tumor:
- g) pseudarthrosis;
- h) revision of previous surgery

#### Summary

{1}------------------------------------------------

K020620 p²/₂

Premarket Notification Blackstone Medical, Inc. Blackstone™ III® Anterior Cervical Plating System Cover Plate (System Addition)

## BASIS OF SUBSTANTIAL EQUIVALENCE:

The Cover Plate addition for the Blackstone™ III° Anterior Cervical Plating System by its very nature is substantially equivalent to the predicate devices listed below:

Blackstone™ III° Anterior Cervical Plating System (K012184) Blackstone™ Anterior Cervical Plate System (K974885)

The FDA has cleared each of these devices, for anterior fixation to the cervical spine from C2 to C7.

{2}------------------------------------------------

## DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows a logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three lines representing its body and wings. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

# MAY 2 3 2002

Mr. Alan Lombardo Director of Engineering Blackstone Medical, Inc. 90 Brookdale Drive Springfield, Massachusetts 01104

Re: K020620

Trade/Device Name: Blackstone™ III° Anterior Cervical Plating System Regulation Number: 21 CFR 888.3060 Regulation Name: Spinal intervertebral body fixation orthosis Regulatory Class: II Product Code: KWQ Dated: February 21, 2002 Received: February 22, 2002

Dear Mr. Lombardo:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

{3}------------------------------------------------

### Page 2 - Mr. Alan Lombardo

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

l. Mark N. Millman

Celia Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

{4}------------------------------------------------

Premarket Notification Blackstone Medical, Inc. Blackstone™ III° Anterior Cervical Plating System Cover Plate (System Addition)

# 510(k) Number: (d2062

page 1 of 1

Device Name: Blackstone™ III° Anterior Cervical Plating System

#### Indications for Use:

Blackstone™ III° Anterior Cervical Plating System is intended for anterior fixation to the cervical spine from C2 to C7. The specific clinical indications include:

- degenerative disc disease (as defined as back pain of discogenic origin with a) degenerative disc confirmed by patient history and radiographic studies);
- b) spondylolisthesis;
- fracture; c)
- d) spinal stenosis;
- deformities (i.e., scoliosis, kyphosis, and/or lordosis); e)
- tumor; f)
- g) pseudarthrosis;
- h) revision of previous surgery

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

for Mark A. Millikin

eneral. Restorative

510(k) Number .