STAXX XD SYSTEM

K101288 · Spine Wave, Inc. · MQP · Sep 10, 2010 · Orthopedic

Device Facts

• Record ID: K101288
• Device Name: STAXX XD SYSTEM
• Applicant: Spine Wave, Inc.
• Product Code: MQP · Orthopedic
• Decision Date: Sep 10, 2010
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3060
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The StaXx® XD System is a vertebral body replacement device intended for use in the thoracolumbar spine (T1-L5) to replace and restore height of a collapsed, damaged, or unstable vertebral body or portion thereof, due to tumor or trauma (i.e., fracture). The system is to be placed bilaterally and used with autograft or allograft and supplemental spinal fixation. The supplemental fixation system that is intended to be used with the StaXx® XD System is the CapSure® PS Spine System.

Device Story

StaXx® XD System is an expandable vertebral body replacement device; composed of stackable PEEK-OPTIMA wafers with 6% Barium Sulfate and added tantalum markers for fluoroscopic visualization. System includes delivery device for implantation and expansion. Used in thoracolumbar spine (T1-L5) to restore vertebral height. Operated by surgeons in clinical/OR settings. Output is physical structural support for the spine; visualized via fluoroscopy to confirm placement. Benefits patient by stabilizing collapsed/damaged vertebrae.

Clinical Evidence

Bench testing only. Mechanical testing included dynamic axial compression and dynamic torsion per ASTM F 2077. All acceptance criteria were met.

Technological Characteristics

Vertebral body replacement system; materials: PEEK-OPTIMA with 6% Barium Sulfate and tantalum markers. Expandable stackable wafer design. Mechanical testing per ASTM F 2077. Non-powered, mechanical device.

Indications for Use

Indicated for patients with collapsed, damaged, or unstable vertebral bodies in the thoracolumbar spine (T1-L5) resulting from tumor or trauma (fracture). Requires bilateral placement with autograft/allograft and supplemental spinal fixation (CapSure® PS Spine System).

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

• StaXx® XD System (K090315)

Reference Devices

• CapSure® PS Spine System

Submission Summary (Full Text)

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**SPINE WAVE**

K1D/288

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# 510(k) Summary StaXx® XD System

### Submitter Information

Spine Wave, Inc. Three Enterprise Drive Suite 210 Shelton, CT 06484 Telephone: [phone] Telefax: 203-944-9493

Contact: Date Prepared: Roaida Rizkallah May 6, 2010

## Device Information

| Trade Name: | StaXx® XD System |
|----------------------|----------------------------------------------|
| Common Name: | Vertebral Body Replacement |
| Classification: | Class II per 21 CFR 888.3060 |
| Classification Name: | Spinal Intervertebral Body Fixation Orthosis |
| Product Code: | MOP |

# Device Description

The StaXx® XD System is composed of wafers that are stacked into an expandable implant to adjust the height of the implant components are manufactured from PEEK-OPTIMA with 6% Barium Sulfate. The system also includes a delivery device to both implant and expand the system.

The purpose of this submission is to gain clearance for the addition of tantalum markers to the implants for added visualization under fluoroscopy.

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K101288
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### Intended Use

The StaXx® XD System is a vertebral body replacement device intended for use in the thoracolumbar spine (T1-L5) to replace and restore height of a collapsed, damaged, or unstable vertebral body or portion thereof, due to tumor or trauma (i.e., fracture). The system is to be placed bilaterally and used with autograft or allograft and supplemental spinal fixation. The supplemental fixation system that is intended to be used with the StaXx® XD System is the CapSure® PS Spine System.

#### Substantial equivalence

The StaXx® XD System described in this submission is substantially equivalent in terms of design, technological characteristics, and intended use, to the following device:

| Predicate Device | Manufacturer | 510(k) No. |
|------------------|------------------|------------|
| StaXx® XD System | Spine Wave, Inc. | K090315 |

The mechanical testing performed on the modified StaXx® XD System included dynamic axial compression and dynamic torsion per ASTM F 2077. Results of mechanical testing indicated that all acceptance criteria were met, demonstrating the StaXx® XD System's substantial equivalence to predicate device. The minor differences between the StaXx® XD System and the predicate device do not raise any new questions of safety or effectiveness. Thus, the StaXx® XD System is substantially equivalent to its predicate device.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus, a symbol often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the caduceus. The logo is black and white.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Spine Wave, Inc. % Ms. Roaida Rizkallah Three Enterprise Drive, Suite 210 Shelton, Connecticut 06484

Re: K101288

Trade/Device Name: StaXx® XD System Regulation Number: 21 CFR 888.3060 Regulation Name: Spinal intervertebral body fixation orthosis Regulatory Class: Class II Product Code: MQP Dated: August 30, 2010 Received: August 31, 2010

Dear Ms. Rizkallah:

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. 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

SEP 1 0 2010

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comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act 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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours.

Barbara Buelhm

Mark N. Melkerson Director Division of Surgical, Orthopedic And Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) Number (if known): KIDL288

SEP 1 0 2010

StaXx® XD System Device Name: _________________________________________________________________________________________________________________________________________________________________

Indications for Use:

The StaXx® XD System is a vertebral body replacement device intended for use in the thoracolumbar spine (TI-L5) to replace and restore height of a collapsed, damaged, or unstable vertebral body or portion thereof, due to tumor or trauma (i.e., fracture). The system is to be placed bilaterally and used with autograft or allograft and supplemental spinal fixation. The supplemental fixation system that is intended to be used with the StaXx® XD System is the CapSure® PS Spine System.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

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Division of

(Division Sign-Off) Division of Surgical, Orthopedic, and Restorative Devices

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KI01288 510(k) Number.