NuVasiveNVM5 System

K152942 · Nu Vasive, Incorporated · PDQ · Jan 13, 2016 · Ear, Nose, Throat

Device Facts

Record IDK152942
Device NameNuVasiveNVM5 System
ApplicantNu Vasive, Incorporated
Product CodePDQ · Ear, Nose, Throat
Decision DateJan 13, 2016
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 874.1820
Device ClassClass 2

Intended Use

The NVM5® System is a medical device that is intended for intraoperative neurophysiologic monitoring during spinal surgery. The device provides information directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5 provides this information by electrically stimulating nerves via electrodes located on surgical accessories and monitoring electromyography (EMG), transcranial or lumbar motor evoked potential (MEP), or somatosensoty evoked potential (SSEP) responses of nerves. The System also integrates Bendini® software used to locate spinal implant instrumentation for the placement of spinal rods. · XLIF (Detection) - The XLIF (Detection) function allows the surgeon to locate and evaluate spinal nerves, and is used as a nerve avoidance tool. · Basic & Dynamic Screw Test - The Screw Test functions allow the surgeon to locate and evaluate spinal nerves by providing proximity information before, during or after bone preparation and placement of bone screws. · Free Run EMG - The Free Run EMG function identifies spontaneous EMG activity of spinal nerves by continually displaying a live stream waveform of any mechanically induced myotome contractions. · Twitch Test (Train of Four) — The Twitch Test Function allows the surgeon to assess moderate degrees of neuromuscular block in effect by evaluating muscle contraction following a train of four stimulation pulses. · MEP - Transcranial or lumbar (i.e., conus in region ofLI-L2) stimulation techniques for motor evoked potentials are used to assess for acute dysfunction in axonal conduction of the corticospinal tract and peripheral nerves. The MEP function provides an adjunctive method to allow the surgeon to monitor spinal cord and motor pathway integrity during procedures with a risk of surgically induced motor injury. · SSEP - The SSEP function allows the surgeon to assess sensory spinal cord function in surgical procedures during which the spinal cord is at risk. · Remote Reader - The Remote Reader function provides real time remote access to the NVM5 System for a monitoring physician outside of the operating room. · Guidance - The Guidance function is intended as an aid for use in either open or percutaneous pedicle cannulation procedures in the lumbar and sacral spine (LI-SI) of adult patients, and when used in conjunction with radiographic imaging and EMG, allows the surgeon to assess the angulation of system accessories relative to patient spinal anatomy for the creation of a cannulation trajectory for bone screw placement. · Bendini - The Bendini Spinal Rod Bending function is used to locate spinal implant system instrumentation (screws, hooks) to determine their relative location to one another to generate bend instructions to shape a spinal rod. A surgeon is able to use those instructions and bend a rod using the Bendini Bender, a mechanical rod bender.

Device Story

NVM5 System provides intraoperative neurophysiologic monitoring during spinal surgery. Inputs: electrical nerve stimulation via surgical accessory electrodes; EMG, MEP, SSEP signals; radiographic imaging for guidance; spatial location of spinal implants. Operation: system processes signals to assess nerve proximity, neuromuscular block, and motor/sensory pathway integrity; integrates Bendini software to calculate spinal rod bend instructions based on implant locations. Output: real-time waveforms, proximity alerts, guidance trajectories, and rod-bending instructions displayed on a touch-screen GUI. Used in OR by surgeons; remote monitoring available for secondary physicians. Benefits: assists in nerve avoidance, pedicle screw placement, and monitoring spinal cord integrity to reduce risk of surgically induced injury.

Clinical Evidence

Bench testing only. Verification and validation testing performed per software requirements. Laboratory bench testing verified accuracy of angle/offset measurements and GUI functionality. No clinical data presented.

Technological Characteristics

System includes patient module, computer, disposable conductive probes, electrodes, and leads. Features IR digitizer for guidance. Connectivity: touch screen GUI, remote monitoring capability. Compliant with IEC 60601-1. Software includes EMG, MEP, SSEP, Guidance, and Bendini rod-bending modules.

Indications for Use

Indicated for intraoperative neurophysiologic monitoring during spinal surgery in adult patients. Used for nerve avoidance (XLIF), screw proximity testing, EMG monitoring, neuromuscular block assessment (Twitch Test), motor pathway integrity monitoring (MEP), sensory spinal cord function assessment (SSEP), and pedicle cannulation guidance (L1-S1).

Regulatory Classification

Identification

A surgical nerve stimulator/locator is a device that is intended to provide electrical stimulation to the body to locate and identify nerves and to test their excitability.

Predicate Devices

Related Devices

Submission Summary (Full Text)

{0}------------------------------------------------ Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread, facing to the right. Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002 January 13, 2016 Nuvasive Incorporated Olga Lewis Lead Specialist, Regulatory Affairs 7475 Lusk Boulevard San Diego, California 92121 Re: K152942 Trade/Device Name: Nuvasive NVM5 System Regulation Number: 21 CFR 874.1820 Regulation Name: Surgical Nerve Stimulator/Locator Regulatory Class: Class II Product Code: PDQ, ETN, GWF, HAW, OLO, IKN Dated: October 2, 2015 Received: October 5, 2015 Dear Ms. Lewis: 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 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated 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. {1}------------------------------------------------ If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Sincerely yours, William J. Heetderks -S for Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K152942 Device Name NuVasive® NVM5 System ## Indications for Use (Describe) The NVM5® System is a medical device that is intended for intraoperative neurophysiologic monitoring during spinal surgery. The device provides information directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5 provides this information by electrically stimulating nerves via electrodes located on surgical accessories and monitoring electromyography (EMG), transcranial or lumbar motor evoked potential (MEP), or somatosensoty evoked potential (SSEP) responses of nerves. The System also integrates Bendini® software used to locate spinal implant instrumentation for the placement of spinal rods. · XLIF (Detection) - The XLIF (Detection) function allows the surgeon to locate and evaluate spinal nerves, and is used as a nerve avoidance tool. · Basic & Dynamic Screw Test - The Screw Test functions allow the surgeon to locate and evaluate spinal nerves by providing proximity information before, during or after bone preparation and placement of bone screws. · Free Run EMG - The Free Run EMG function identifies spontaneous EMG activity of spinal nerves by continually displaying a live stream waveform of any mechanically induced myotome contractions. · Twitch Test (Train of Four) — The Twitch Test Function allows the surgeon to assess moderate degrees of neuromuscular block in effect by evaluating muscle contraction following a train of four stimulation pulses. · MEP - Transcranial or lumbar (i.e., conus in region ofLI-L2) stimulation techniques for motor evoked potentials are used to assess for acute dysfunction in axonal conduction of the corticospinal tract and peripheral nerves. The MEP function provides an adjunctive method to allow the surgeon to monitor spinal cord and motor pathway integrity during procedures with a risk of surgically induced motor injury. · SSEP - The SSEP function allows the surgeon to assess sensory spinal cord function in surgical procedures during which the spinal cord is at risk. · Remote Reader - The Remote Reader function provides real time remote access to the NVM5 System for a monitoring physician outside of the operating room. · Guidance - The Guidance function is intended as an aid for use in either open or percutaneous pedicle cannulation procedures in the lumbar and sacral spine (LI-SI) of adult patients, and when used in conjunction with radiographic imaging and EMG, allows the surgeon to assess the angulation of system accessories relative to patient spinal anatomy for the creation of a cannulation trajectory for bone screw placement. · Bendini - The Bendini Spinal Rod Bending function is used to locate spinal implant system instrumentation (screws, hooks) to determine their relative location to one another to generate bend instructions to shape a spinal rod. A surgeon is able to use those instructions and bend a rod using the Bendini Bender, a mechanical rod bender. Type of Use (Select one or both, as applicable) > Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C) # CONTINUE ON A SEPARATE PAGE IF NEEDED. {3}------------------------------------------------ This section applies only to requirements of the Paperwork Reduction Act of 1995. # *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: > Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov "An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number." {4}------------------------------------------------ Image /page/4/Picture/0 description: The image shows the logo for Nuvasive. The logo consists of a purple and gray leaf-like shape on the left, followed by the word "NUVASIVE" in gray. Below the word "NUVASIVE" is the phrase "Speed of Innovation" in a smaller font. # 510(k) Summary In accordance with Title 21 of the Code of Federal Regulations, Part 807, and in particular 21 CFR §807.92, the following summary of information is provided: ### A. Submitted by: Olga Lewis Lead Specialist, Regulatory Affairs NuVasive, Incorporated 7475 Lusk Blvd. San Diego, California 92121 Telephone: (858) 909-1800 Date Prepared: October 2, 2015 ### B. Device Name | Trade or Proprietary Name: | <i>NuVasive</i> ® <i>NVM5</i> ® System | |----------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Common or Usual Name: | Neurological surgical monitor;<br>Stereotaxic Instrument | | Classification Name: | Surgical Nerve Stimulator/Locator;<br>Evoked response electrical stimulator;<br>Neurological stereotaxic instrument;<br>Electromyography (EMG) monitor/stimulator | | Device Class: | Class II | | Classification: | §874.1820, §882.1870, §882.4560, §890.1375 | | Product Code: | PDQ, ETN, GWF, HAW, IKN, OLO | ### C. Predicate Devices The subject NuVasive NVM5 System is substantially equivalent to the predicate NuVasive NVM5 System K143641. ### D. Device Description The NVM5 System is a medical device that is intended for intraoperative neurophysiologic monitoring during spinal surgery. The device provides information directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5 provides this information by electrically stimulating nerves via electrodes located on surgical accessories and monitoring electromyography (EMG), motor evoked potential (MEP) or somatosensory evoked potential (SSEP) responses of nerves. Moreover, a Twitch Test function is utilized to test the ability of the nerve to respond, or contract, following four stimulation pulses to determine the presence of neuromuscular block. Additionally, the NVM5 System includes an integrated stereotactic guidance system (NVM5 Guidance) to support the delivery of pedicle screws during EMG monitoring. The System also integrates Bendini software used to locate spinal implant instrumentation for the placement of spinal rods. Lastly, the system also offers an optional screen sharing application to allow a secondary physician to remotely view the events represented on the NVM5 user interface. In summary, the NVM5 System includes the following six (6) software functionalities / modalities: {5}------------------------------------------------ Image /page/5/Picture/0 description: The image shows the Nuvasive logo. The logo consists of a purple and gray abstract shape on the left, followed by the word "NUVASIVE" in gray. Below the word "NUVASIVE" is the phrase "Speed of Innovation" in a smaller font size. - 1. Electromyography (EMG) - 2. Motor Evoked Potential (MEP) - 3. Somatosensory Evoked Potential (SSEP) - 4. Remote Reader - 5. Guidance - 6. Bendini The NVM5 System hardware consists of a Patient Module (PM) and computer, as well as accompanying accessory components which consist of an assortment of disposable conductive probes, electrodes, and electrode leads. ### E. Intended Use The NVM5 System is a medical device that is intended for intraoperative neurophysiologic monitoring during spinal surgery. The device provides information directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5 provides this information by electrically stimulating nerves via electrodes located on surgical accessories and monitoring electromyography (EMG), transcranial or lumbar motor evoked potential (MEP), or somatosensory evoked potential (SSEP) responses of nerves. The System also integrates Bendini® software used to locate spinal implant instrumentation for the placement of spinal rods. - XLIF (Detection) The XLIF (Detection) function allows the surgeon to locate and . evaluate spinal nerves, and is used as a nerve avoidance tool. - Basic & Dynamic Screw Test The Screw Test functions allow the surgeon to locate and . evaluate spinal nerves by providing proximity information before, during or after bone preparation and placement of bone screws. - Free Run EMG The Free Run EMG function identifies spontaneous EMG activity of • spinal nerves by continually displaying a live stream waveform of any mechanically induced myotome contractions. - . Twitch Test (Train of Four) - The Twitch Test Function allows the surgeon to assess moderate degrees of neuromuscular block in effect by evaluating muscle contraction following a train of four stimulation pulses. - MEP Transcranial or lumbar (i.e., conus in region of L1-L2) stimulation techniques for . motor evoked potentials are used to assess for acute dysfunction in axonal conduction of the corticospinal tract and peripheral nerves. The MEP function provides an adjunctive method to allow the surgeon to monitor spinal cord and motor pathway integrity during procedures with a risk of surgically induced motor injury. - SSEP The SSEP function allows the surgeon to assess sensory spinal cord function in • surgical procedures during which the spinal cord is at risk. - Remote Reader The Remote Reader function provides real time remote access to the • NVM5 System for a monitoring physician outside of the operating room. - Guidance The Guidance function is intended as an aid for use in either open or . percutaneous pedicle cannulation procedures in the lumbar and sacral spine (L1-S1) of adult {6}------------------------------------------------ patients, and when used in conjunction with radiographic imaging and EMG, allows the surgeon to assess the angulation of system accessories relative to patient spinal anatomy for the creation of a cannulation trajectory for bone screw placement. - Bendini The Bendini Spinal Rod Bending function is used to locate spinal implant system ● instrumentation (screws, hooks) to determine their relative location to one another to generate bend instructions to shape a spinal rod. A surgeon is able to use those instructions and bend a rod using the Bendini Bender, a mechanical rod bender. ### Technological Characteristics F. As was established in this submission, the subject NVM5 System is substantially equivalent to other predicate devices cleared by the FDA for commercial distribution in the United States. The subject device was shown to be substantially equivalent and have equivalent technological characteristics to its predicate device through comparison in areas including design, intended use, material composition, and functions. The technological differences within this 510(k) that were shown to be substantially equivalent to the predicates include additional angular and offset spinal parameter assessment. {7}------------------------------------------------ NUVASIVE. | Specification/<br>Property | Predicate Device<br>NuVasive NVM5 System (K143641) | Subject Device<br>NuVasive NVM5 System | |--------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Intended Use /<br>Indications for<br>Use | The NVM5® System is a medical device that is intended for intraoperative<br>neurophysiologic monitoring during spinal surgery. The device provides information<br>directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5<br>provides this information by electrically stimulating nerves via electrodes located on<br>surgical accessories and monitoring electromyography (EMG), transcranial or lumbar<br>motor evoked potential (MEP), or somatosensory evoked potential (SSEP) responses of<br>nerves. The System also integrates Bendini® software used to locate spinal implant<br>instrumentation for the placement of spinal rods.<br><br>XLIF (Detection) - The XLIF (Detection) function allows the surgeon to locate<br>and evaluate spinal nerves, and is used as a nerve avoidance tool.<br>Basic & Dynamic Screw Test - The Screw Test functions allow the surgeon to<br>locate and evaluate spinal nerves by providing proximity information before,<br>during or after bone preparation and placement of bone screws.<br>Free Run EMG - The Free Run EMG function identifies spontaneous EMG<br>activity of spinal nerves by continually displaying a live stream waveform of any<br>mechanically induced myotome contractions.<br>Twitch Test (Train of Four) - The Twitch Test Function allows the surgeon to<br>assess moderate degrees of neuromuscular block in effect by evaluating muscle<br>contraction following a train of four stimulation pulses.<br>MEP - Transcranial or lumbar (i.e., conus in region of L1-L2) stimulation<br>techniques for motor evoked potentials are used to assess for acute dysfunction in<br>axonal conduction of the corticospinal tract and peripheral nerves. The MEP<br>function provides an adjunctive method to allow the surgeon to monitor spinal<br>cord and motor pathway integrity during procedures with a risk of surgically<br>induced motor injury.<br><br>SSEP - The SSEP function allows the surgeon to assess sensory spinal cord<br>function in surgical procedures during which the spinal cord is at risk.<br>Remote Reader - The Remote reader function provides real time remote access to<br>the NVM5 System for a monitoring physician outside of the operating room<br>Guidance - The Guidance function is intended as an aid for use in either open or<br>percutaneous pedicle cannulation procedures in the lumbar and sacral spine<br>(L1-S1) of adult patients, and when used in conjunction with radiographic<br>imaging and EMG, allows the surgeon to assess the angulation of system<br>accessories relative to patient spinal anatomy for the creation of a cannulation<br>trajectory for bone screw placement.<br><br>Bendini - The Bendini Spinal Rod Bending function is used to locate spinal<br>implant system instrumentation (screws, hooks) to determine their relative<br>location to one another to generate bend instructions to shape a spinal rod. A<br>surgeon is able to use those instructions and bend a rod using the Bendini Bender,<br>a mechanical rod bender. | The NVM5® System is a medical device that is intended for intraoperative<br>neurophysiologic monitoring during spinal surgery. The device provides information<br>directly to the surgeon, to help assess a patient's neurophysiologic status. NVM5<br>provides this information by electrically stimulating nerves via electrodes located on<br>surgical accessories and monitoring electromyography (EMG), transcranial or lumbar<br>motor evoked potential (MEP), or somatosensory evoked potential (SSEP) responses of<br>nerves. The System also integrates Bendini® software used to locate spinal implant<br>instrumentation for the placement of spinal rods.<br><br>XLIF (Detection) - The XLIF (Detection) function allows the surgeon to<br>locate and evaluate spinal nerves, and is used as a nerve avoidance tool.<br>Basic & Dynamic Screw Test - The Screw Test functions allow the surgeon to<br>locate and evaluate spinal nerves by providing proximity information before,<br>during or after bone preparation and placement of bone screws.<br>Free Run EMG - The Free Run EMG function identifies spontaneous EMG<br>activity of spinal nerves by continually displaying a live stream waveform of<br>any mechanically induced myotome contractions.<br>Twitch Test (Train of Four) - The Twitch Test Function allows the surgeon to<br>assess moderate degrees of neuromuscular block in effect by evaluating<br>muscle contraction following a train of four stimulation pulses.<br>MEP - Transcranial or lumbar (i.e., conus in region of L1-L2) stimulation<br>techniques for motor evoked potentials are used to assess for acute dysfunction<br>in axonal conduction of the corticospinal tract and peripheral nerves. The<br>MEP function provides an adjunctive method to allow the surgeon to monitor<br>spinal cord and motor pathway integrity during procedures with a risk of<br>surgically induced motor injury.<br><br>SSEP - The SSEP function allows the surgeon to assess sensory spinal cord<br>function in surgical procedures during which the spinal cord is at risk.<br>Remote Reader - The Remote reader function provides real time remote<br>access to the NVM5 System for a monitoring physician outside of the<br>operating room<br>Guidance - The Guidance function is intended as an aid for use in either open<br>or percutaneous pedicle cannulation procedures in the lumbar and sacral spine<br>(L1-S1) of adult patients, and when used in conjunction with radiographic<br>imaging and EMG, allows the surgeon to assess the angulation of system<br>accessories relative to patient spinal anatomy for the creation of a cannulation<br>trajectory for bone screw placement.<br><br>Bendini - The Bendini Spinal Rod Bending function is an intraoperative<br>assessment tool used to locate spinal implant system instrumentation (screws,<br>hooks) to determine their relative location to one another to generate bend<br>instructions to shape a spinal rod. A surgeon is able to use those instructions<br>and bend a rod using the Bendini Bender. | | Specification/<br>Property | Predicate Device<br>NuVasive NVM5 System (K143641) | Subject Device<br>NuVasive NVM5 System | | Software<br>Modalities /<br>Functionalities | XLIF (Detection) Basic & Dynamic Screw Test Free Run EMG Twitch Test TceMEP SSEP Remote Monitoring Guidance Bendini | XLIF (Detection) Basic & Dynamic Screw Test Free Run EMG Twitch Test MEP SSEP Remote Monitoring Guidance Bendini | | Algorithms | XLIF (Detection) Basic & Dynamic Screw Test Free Run EMG Twitch Test TceMEP SSEP Guidance Bendini | XLIF Detection – Identical algorithm as predicate Basic & Dynamic Screw Test – Identical algorithm as<br>predicate Free Run EMG – Identical algorithm as predicate Twitch Test (Train of Four) – Identical algorithm as<br>predicate MEP - Modified stimulation parameters SSEP – Addition of baseline algorithm and optional view Guidance - Identical algorithm as predicate Bendini - Identical rod-bending algorithm as predicate | | Total Available<br>Channels | 32 | 32 | | Headbox/<br>Patient Module<br>IEC 60601-1<br>Compliant | Yes | Yes | | Full Scale View<br>Range | $± 0.5µV to ± 8mV$ | $± 0.5µV to ± 8mV$ | | Frequency<br>Response | 3 Hz to 4.8 kHz | 3 Hz to 4.8 kHz | | User Interface | NuVasive-supplied computer or<br>NuVasive provided touch screen and [optional] keyboard/mouse…
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