MATISSE ANTERIOR CERVICAL INTERBODY FUSION CAGE SYSTEM

K121569 · Accel Spine · ODP · Jul 27, 2012 · Orthopedic

Device Facts

• Record ID: K121569
• Device Name: MATISSE ANTERIOR CERVICAL INTERBODY FUSION CAGE SYSTEM
• Applicant: Accel Spine
• Product Code: ODP · Orthopedic
• Decision Date: Jul 27, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3080
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Matisse Anterior Cervical Interbody Fusion Cage system is indicated for use in skeletally mature patients with degenerative disc disease (DDD) of the cervical spine with accompanying radicular symptoms at one disc level. DDD is defined as discogenic pain with degeneration of the disc confirmed by patient history and radiographic studies. Matisse Anterior Cervical Interbody Fusion Cage system is used to facilitate intervertebral body fusion in the cervical spine at the C3 to C7 disc levels using autograft bone. Matisse Anterior Cervical Interbody Fusion Cage system is to be used with supplemental fixation. Patients should have at least six (6) weeks of non-operative treatment prior to treatment with an intervertebral cage.

Device Story

Intervertebral body fusion device; used in cervical spine (C3-C7) to facilitate fusion in patients with degenerative disc disease. Device implanted by surgeon during spinal fusion procedure; requires supplemental fixation. Acts as structural spacer to maintain disc space height while bone graft (autograft) promotes fusion. Available in various sizes/configurations to match patient anatomy. Manufactured from PEEK-OPTIMA LT1 with Tantalum marker pins for radiographic visualization.

Clinical Evidence

Bench testing only. Testing conducted per ASTM F 2077 (static/dynamic axial compression, compression-shear, torsion, expulsion) and ASTM F 2267 (static subsidence).

Technological Characteristics

Materials: PEEK-OPTIMA LT1, Tantalum marker pins (ASTM F 560). Form factor: Intervertebral cage in various sizes/configurations. Energy source: None (mechanical). Sterilization: Not specified. Connectivity: None.

Indications for Use

Indicated for skeletally mature patients with cervical degenerative disc disease (DDD) and radicular symptoms at one level (C3-C7). Requires autograft bone and supplemental fixation. Patients must have failed at least 6 weeks of non-operative treatment.

Regulatory Classification

Identification

An intervertebral body fusion device is an implanted single or multiple component spinal device made from a variety of materials, including titanium and polymers. The device is inserted into the intervertebral body space of the cervical or lumbosacral spine, and is intended for intervertebral body fusion.

Special Controls

*Classification.* (1) Class II (special controls) for intervertebral body fusion devices that contain bone grafting material. The special control is the FDA guidance document entitled “Class II Special Controls Guidance Document: Intervertebral Body Fusion Device.” See § 888.1(e) for the availability of this guidance document.(2) Class III (premarket approval) for intervertebral body fusion devices that include any therapeutic biologic (e.g., bone morphogenic protein). Intervertebral body fusion devices that contain any therapeutic biologic require premarket approval. (c) *Date premarket approval application (PMA) or notice of product development protocol (PDP) is required.* Devices described in paragraph (b)(2) of this section shall have an approved PMA or a declared completed PDP in effect before being placed in commercial distribution.

Predicate Devices

• Lexus Cervical Intervertebral body Fusion Cage System (K120840)
• LDR Spine Cervical Interbody Fusion System (K091088, K113559)
• TRYPTIK CA Anterior Intersomatic Cervical Cage (K091873)
• SHELL Cages (K080401)
• COALITION TM Spacer (K083389)

Submission Summary (Full Text)

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JUL 2 7 2012

AccessPINE

## 510(k) SUMMARY

The following 510(k) summary is being submitted as required by 21 CFR 807.92(a):

1.

Accel SPINE

| Accel SPINE. |
|----------------------------------------------|
| 14850 Quorum Dr.Suite220Dallas, TX 75254,USA |
| Daniel Chon |
| Phone. [phone] |
| FAX .[phone] |
| E-mail: [e-mail] |
| May 22, 2012 |
| |

## 2. Device Identification

| Trade Name | Matisse Anterior Cervical Interbody Fusion Cage system |
|---------------------|--------------------------------------------------------|
| CommonName | Intervertebral Body Fusion Device |
| Classification Name | intervertebral fusion device with bone graft, cervical |
| Regulation Number | 21 CFR 888.3080 |
| Regulatory Class | Class II |
| Product Code | ODP |
| | |

## 3. Predicate or Legally Marketed Devices which are Substantially Equivalent

The design feature and indications for use for the subject Matisse Anterior Cervical Interbody Fusion Cage system isexactly identical to Lexus Cervical Intervertebral body Fusion Cage System cleared in K120840 and substantially equivalent to the following predicates:

- L&K Biomed Co.,Ltd.:,Lexus Cervical Intervertebral body Fusion Cage System (K 120840) �
- . LDR Spine: LDR Spine Cervical Interbody Fusion System(K091088,K113559)
- Spine Art: TRYPTIK CA Anterior Intersomatic Cervical Cage (K091873) ◆
- Advanced Medical Technologies AG: SHELL Cages (K080401) ●
- Globus Medical Inc .: COALITION TM Spacer (K083389) .

### 4. Description of the Device

Matisse Anterior Cervical Interbody Fusion Cage system intended for use as an . interbody fusion cage device and must be used with supplemental fixation. The devices are available in a variety of different sizes and configurations to accommodate anatomical variation in different vertebral levels and/or patient anatomy. The devices are made of PEEK-OPTIMA®LTlwith marker pins made of Tantalum (ASTMF 560).

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CAccelSPINE

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K121569

## 5. Indications for Use

Matisse Anterior Cervical Interbody Fusion Cage system is indicated for use in skeletally mature patients with degenerative disc disease (DDD) of the cervical spine with accompanying radicular symptoms at one disc level. DDD is defined as discogenic pain with degeneration of the disc confirmed by patient history and radiographic studies. Matisse Anterior Cervical Interbody Fusion Cage system is used to facilitate intervertebral body fusion in the cervical spine at the C3 to C7 disc levels using autograft bone. Matisse Anterior Cervical Interbody Fusion Cage system is to be used with supplemental fixation. Patients should have at least six (6) weeks of nonoperative treatment prior to treatment with an intervertebral cage.

### 6. Discussion of the Non-clinical Testing

The Matisse Anterior Cervical Interbody Fusion Cage system and Lexus Cervical Intervertebral body Fusion Cage System (K 120840) is identical products. And the non-clinical testing conducted on the Lexus predicate applicable to represent the Matisse Anterior Cervical Interbody Fusion Cage system.

The Matisse Anterior Cervical Interbody Fusion Cagedevices were tested under the name of Lexus Cervical Intervertebral body Fusion Cage System (K 120840)according to the ASTM F 2077, specifically, Static and Dynamic Axial Compression, Static and Dynamic Compression-Shear Testing, Static and Dynamic Torsion Testing, Expulsion Testing and Static Subsidence testing under Axial Compression, per ASTM F 2267.

## 7. Summary of Technology Characteristics

The Matisse Anterior Cervical Interbody Fusion Cage system and Lexus Cervical Intervertebral body Fusion Cage System (K 120840)identical products. Both product are same in design and sizes and all manufacturing process, materials and the same intended use.

And The Matisse Anterior Cervical Interbody Fusion Cage systemshares technological characteristics similar to the predicate devices.

These characteristics include similar design, the same materials and the same intended use.

#### 8. Conclusion+

The Matisse Anterior Cervical Interbody Fusion Cage system is substantially equivalent to the device referenced above and is therefore safe and effective for its intended use.

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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 consists of a stylized eagle with its wings spread, and three wavy lines below it. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circle around the eagle.

#### Public Health Service

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

Accel Spine, LLC % Ms. KiHyang Kim L&K Biomed Company, Limited #1104, Ace High-end Tower 3 cha, 371-50 Gasan-Dong, Geumcheon-gu, Seoul 153-803 Republic of Korea

JUL 2 7 2012

Re: K121569

Trade/Device Name: Matisse Anterior Cervical Interbody Fusion Cage System Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral body fusion device Regulatory Class: Class II Product Code: ODP Dated: May 22, 2012 Received: May 31, 2012

Dear Ms. Kim:

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 comply with all the Act's requirements, including, but not limited to: registration and listing (21

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## Page 2- Ms. Kim

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.

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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## Indications for Use Statement

510(k) Number (if known): K121569

Device Name:Matisse Anterior Cervical Interbody Fusion Cage system

### Indications For Use:

Matisse Anterior Cervical Interbody Fusion Cage system is indicated for use in skeletally mature patients with degenerative disc disease (DDD) of the cervical spine with accompanying radicular symptoms at one disc level. DDD is defined as discogenic pain with degeneration of the disc confirmed by patient history and radiographic studies. Matisse Anterior Cervical Interbody Fusion Cage system is used to facilitateintervertebral body fusion in the cervical spine at the C3 to C7 disc levels using autograft bone. Matisse Anterior Cervical Interbody Fusion Cage system is to be used withsupplemental fixation. Patients should have at least six (6) weeks of non-operative treatment prior to treatment with an intervertebral cage.

Prescription Use

(Part 21 CER801 Subpart D)

AND/OR

Over-The-Counter Use

(21 CER801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (OED)

Traditions 910(R)

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

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