Navigated ELEVATE Inserter, Navigated Disc Prep Instruments

K163581 · Medtronic Sofamor Danek USA, Inc. · OLO · Apr 14, 2017 · Neurology

Device Facts

• Record ID: K163581
• Device Name: Navigated ELEVATE Inserter, Navigated Disc Prep Instruments
• Applicant: Medtronic Sofamor Danek USA, Inc.
• Product Code: OLO · Neurology
• Decision Date: Apr 14, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 882.4560
• Device Class: Class 2

Intended Use

The Navigated Disc Preparation Instruments are intended to facilitate a discectomy during spinal surgery. The Navigated CAPSTONE™ Trials are intended to be used to facilitate implant size selection of Medtronic intervertebral body fusion devices during spinal surgery. When the Navigated Rotating Shavers are used as trials for ELEVATE™ Spinal System, they are intended to be used to facilitate implant size selection. The Navigated Probe is intended to be used during pedicle and disc preparation during spinal fusion procedures. The Navigated Inserters are intended to be used for the placement of an implant. Navigated instruments are specifically designed for use with the StealthStation® System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as a skull, a long bone, or vertebra, can be identified relative to a CT or MR based model, fluoroscopy images, or digitized landmarks of the anatomy.

Device Story

Navigated surgical instruments (inserters, shavers, probes, trials) used during spinal surgery; designed for use with StealthStation® System. Instruments feature optical tracking markers; system tracks position relative to patient anatomy (CT/MR/fluoroscopy). Surgeon uses instruments to perform discectomy, prepare pedicles/discs, and place implants. Navigation provides real-time visual feedback on instrument position within surgical site; assists surgeon in accurate implant sizing and placement. Benefits include improved surgical precision and guidance during spinal procedures.

Clinical Evidence

Bench testing only. Testing included navigation accuracy analysis (2D/3D), anatomical simulated use, navigation simulated use, CAD model evaluation, implant/instrument mating verification, and software interface testing (Spine Tools package).

Technological Characteristics

Materials: stainless steel, silicone, aluminum (case/trays), nylon (brackets). Principle: optical navigation via StealthStation® System. Form factor: reusable surgical instruments. Connectivity: compatible with S7/Synergy Spine 2.1 application. Sterilization: non-sterile (reusable).

Indications for Use

Indicated for patients undergoing spinal surgery requiring discectomy, pedicle/disc preparation, or spinal fusion procedures where stereotactic navigation is appropriate.

Regulatory Classification

Identification

A stereotaxic instrument is a device consisting of a rigid frame with a calibrated guide mechanism for precisely positioning probes or other devices within a patient's brain, spinal cord, or other part of the nervous system.

Predicate Devices

• Navigated Disc Prep Instruments (K150231)
• Navigated Interbody Trials and Inserter (K131425)
• ELEVATE™ Spinal System (K142559)

Submission Summary (Full Text)

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

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of the department's name arranged in a circular fashion around a symbol. The symbol is a stylized representation of three human profiles facing to the right, stacked on top of each other.

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

April 14, 2017

Medtronic Sofamor Danek USA, Inc Laveeda Leflore Regulatory Affairs Specialist 1800 Pyramid Place Memphis. Tennessee 38132

Re: K163581

Trade/Device Name: Navigated Elevate Inserter and Navigated Disc Prep Instruments Regulation Number: 21 CFR 882.4560 Regulation Name: Stereotaxic Instrument Regulatory Class: Class II Product Code: OLO Dated: December 19, 2016 Received: December 20, 2016

Dear Laveeda Leflore:

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 [phone] or [phone] 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 [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely,

Mark N. Melkerson -S

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

Enclosure

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

# Indications for Use

510(k) Number (if known) K163581

### Device Name

Navigated ELEVATE™ Inserter and Navigated Disc Prep Instruments.

### Indications for Use (Describe)

The Navigated Disc Preparation Instruments are intended to facilitate a discectomy during spinal surgery. The Navigated CAPSTONE™ Trials are intended to be used to facilitate implant size selection of Medtronic intervertebral body fusion devices during spinal surgery. When the Navigated Rotating Shavers are used as trials for ELEVATE™ Spinal System, they are intended to be used to facilitate implant size selection.

The Navigated Probe is intended to be used during pedicle and disc preparation during spinal fusion procedures. The Navigated Inserters are intended to be used for the placement of an implant.

Navigated instruments are specifically designed for use with the StealthStation® System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as a skull, a long bone, or vertebra, can be identified relative to a CT or MR based model, fluoroscopy images, or digitized landmarks of the anatomy.

| Type of Use (Select one or both, as applicable) | |
|--------------------------------------------------|---------------------------------------------|
| X Prescription Use (Part 21 CFR 801 Subpart D) | Over-The-Counter Use (21 CFR 801 Subpart C) |

## CONTINUE ON A SEPARATE PAGE IF NEEDED.

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."

| FORM FDA 3881 (8/14) | | |
|----------------------|--|--|
| | | |

Page of Page 1 of 1.

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

# 510(k) Summarv December 19, 2016

- l. Company: Medtronic Sofamor Danek, USA Inc. 1800 Pyramid Place Memphis. TN 38132 Telephone: [phone]
- Laveeda Leflore Contact: Regulatory Affairs Specialist Telephone: [phone] Email: [e-mail]
- II. Proprietary Trade Name: Navigated ELEVATE™ Inserter and Navigated Disc Prep Instruments.

Common Name: Stereotaxic Instrument, Navigated Instruments

Classification Name: Stereotaxic Instrument (21 CFR 882.4560)

Classification: Class II

Product Code: OLO

#### III. Predicate Device:

- Navigated Disc Prep Instruments (K150231, S.E. 06/16/2015) primary predicate ●
- . Navigated Interbody Trials and Inserter (K131425, S.E. 08/14/2013) - secondary predicate
- ELEVATE™ Spinal System (K142559, S.E. 06/09/2015) - secondary predicate

The predicate devices have not been subject to a design-related recall.

#### IV. Product Description:

The Navigated ELEVATE™ Inserter and navigated rotating shavers are non-sterile, reusable surgical instruments that are intended to be used to facilitate a discectomy and placement of implants during spinal surgery procedure. The subject devices are designed specifically to be used with ELEVATE™ Spinal System and are also compatible with the StealthStation. These devices are offered in non-sterile form and are reusable. This subject devices are manufactured from stainless steel and silicone. The case and trays are manufactured from aluminum with either silicone or nylon coated brackets.

#### V. Indications for Use:

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

The Navigated Disc Preparation Instruments are intended to be used to facilitate a discectomy during spinal surgery. The Navigated CAPSTONE™ Trials are intended to be used to facilitate implant size selection of Medtronic intervertebral body fusion devices during spinal surgery. When the Navigated Rotating Shavers are used as trials for ELEVATE™ Spinal System, they are intended to facilitate implant size selection.

The Navigated Probe is intended to be used during pedicle and disc preparation during spinal fusion procedures. The Navigated Inserters are intended to be used for the placement of an implant.

Navigated instruments are specifically designed for use with the StealthStation® System, which is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as a skull, a long bone, or vertebra, can be identified relative to a CT or MR based model, fluoroscopy images, or digitized landmarks of the anatomy.

#### VI. Comparison of the Technological Characteristics with the Predicate Device:

The subject Navigated ELEVATE™ Inserter is intended to be used for the placement of implants. The subject navigated rotating shavers will have a dual indication. They can be used as shavers to facilitate a discectomy or as trials to facilitate implant size (height) selection of the ELEVATE™ Spinal System implants during a spinal surgery procedure. These instruments are specifically designed for use with the StealthStation® System , which allows for optical navigation of the surgical instruments. These devices have similar designs and uses to the predicate devices and incorporate the same design features to enable navigation capabilities. Like the predicate devices, the subject Navigated ELEVATE™ Inserter and navigated rotating shavers are also made from stainless steel.

The instrument modifications detailed in this submission have no impact on the technological characteristics of either the existing instruments or the StealthStation® System.

{5}------------------------------------------------

#### VII. Performance Data

Testing was completed to ensure the functionality and compatibility with the identified Medtronic products. The following table summarizes the performance testing completed:

| Test | Description |
|----------------------------------------------|---------------------------------------------------------------------------------------------------------------|
| Navigation<br>Accuracy Analysis | Confirmed navigated instrument accuracy in both 2D and 3D space. |
| Anatomical<br>Simulated Use | Confirmed instrument functionality under expected use conditions. |
| Navigation<br>Simulated Use | Confirmed navigation system functionality under expected use conditions. |
| CAD Model<br>Evaluation | Verified that the CAD models are accurately reflected in the application software. |
| Implant/Instrument<br>Mating Conditions | Verified that the instruments can be assembled with the appropriate devices according to their intended use. |
| Spine Tools<br>Package<br>Functional Testing | Verified that the Spine Tools package has met the required interface needs of the spine application software. |

Table 5-1: Description of Performance Testing

The Navigated ELEVATE™ Inserter and the rotating shavers will use Tools Package Version 25, which will be compatible with the Synergy Spine 2.1 application on the S7.

#### VIII. Conclusions

That Navigated ELEVATE™ Inserter and the navigated rotating shavers have been shown through comparison and testing to be substantially equivalent to the identified predicate devices.