Capstone Control™ Spinal System

K190165 · Medtronic Sofamor Danek USA, Inc. · MAX · May 6, 2019 · Orthopedic

Device Facts

• Record ID: K190165
• Device Name: Capstone Control™ Spinal System
• Applicant: Medtronic Sofamor Danek USA, Inc.
• Product Code: MAX · Orthopedic
• Decision Date: May 6, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3080
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Capstone Control™ Spinal System is intended to be used in spinal fusion procedures for patients diagnosed with Degenerative Disc Disease (DDD) at 1 or 2 contiguous levels from L2 to S1. DDD patients may also have up to Grade 1 spondylolisthesis or retrolisthesis at the involved levels. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. When used for these indications, the Capstone Control™ Spinal System, is intended for use with supplemental fixation systems cleared for use in the lumbar spine. Additionally, the Capstone Control™ Spinal System can be used to provide anterior column support in patients diagnosed with degenerative scoliosis as an adjunct to pedicle screw fixation. These patients should be skeletally mature and have had 6 months of nonoperative treatment. The Capstone Control™ Spinal System is intended to be used with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft when the subject device is used as an adjunct to fusion. These implants may be implanted via an open or a minimally invasive posterior or transforaminal approach. The 18mm Capstone Control™ Spinal System implant can only be implanted via a Posterior (PLIF) approach. When using the 18mm Capstone Control™ Spinal System implant, a minimum of 2 implants are required per spinal level.

Device Story

Capstone Control™ Spinal System consists of convex PEEK cages with bullet nose and angular teeth; includes unalloyed tantalum markers for radiographic visualization. Implants inserted between vertebral bodies to provide support and correction during interbody fusion; hollow geometry allows packing with autogenous or allogenic bone graft. Used in lumbar spine (L2-S1) via open or minimally invasive posterior/transforaminal approaches; 18mm implants restricted to PLIF approach with minimum 2 implants per level. Operated by surgeons in clinical/OR settings. Output is structural support for spinal fusion; aids in disc height restoration and stabilization. Benefits patients by facilitating fusion in DDD or degenerative scoliosis cases.

Clinical Evidence

Bench testing only. Mechanical verification performed per ASTM F2077 (static compression, static compression-shear, compression fatigue, compression-shear fatigue) and ASTM F2267 (subsidence). Biocompatibility established via material history. Bacterial endotoxin testing confirmed compliance with ANSI/AAMI ST72 and USP <161> (limit 20 EU/device). MRI compatibility re-evaluated and confirmed as MR-Conditional.

Technological Characteristics

Materials: Polyetheretherketone (PEEK) and unalloyed tantalum markers. Instruments: Stainless steel. Design: Convex cages with bullet nose and angular teeth. Standards: ASTM F2077, ASTM F2267, ANSI/AAMI ST72, USP <161>. Connectivity: None. Sterilization: Not specified (implants sterile, trials non-sterile).

Indications for Use

Indicated for skeletally mature patients with Degenerative Disc Disease (DDD) at 1-2 contiguous levels (L2-S1), including those with up to Grade 1 spondylolisthesis or retrolisthesis, or degenerative scoliosis requiring anterior column support. Requires 6 months of failed nonoperative 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

• Capstone Control™ Spinal System (K171107)
• Capstone Control™ Spinal System (K120368)
• Perimeter® Interbody Fusion Device (K090353)
• Capstone® Spinal System (K073291)

Submission Summary (Full Text)

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May 6, 2019

Medtronic Sofamor Danek USA, INC. Mr. Justin O'Connor Senior Regulatory Affairs Specialist 1800 Pyramid Place Memphis, Tennessee 38132

### Re: K190165

Trade/Device Name: Capstone Control™ Spinal System Regulation Number: 21 CFR 888.3080 Regulation Name: Intervertebral Body Fusion Device Regulatory Class: Class II Product Code: MAX Dated: January 31, 2019 Received: January 31, 2019

### Dear Mr. O'Connor:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

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801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

for

CAPT Raquel Peat, PhD, MPH, USPHS Director Office of Health Technology 6 Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known) K190165

Device Name Capstone ControlTM Spinal System

#### Indications for Use (Describe)

The Capstone Control™ Spinal System is intended to be used in spinal fusion procedures for patients diagnosed with Degenerative Disc Disease (DDD) at 1 or 2 contiguous levels from L2 to S1. DDD patients may also have up to Grade 1 spondylolisthesis or retrolisthesis at the involved levels. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. When used for these indications, the Capstone Control™ Spinal System, is intended for use with supplemental fixation systems cleared for use in the lumbar spine.

Additionally, the Capstone Control™ Spinal System can be used to provide anterior column support in patients diagnosed with degenerative scoliosis as an adjunct to pedicle screw fixation.

These patients should be skeletally mature and have had 6 months of nonoperative treatment. The Capstone Control™ Spinal System is intended to be used with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft when the subject device is used as an adjunct to fusion. These implants may be implanted via an open or a minimally invasive posterior or transforaminal approach.

The 18mm Capstone Control™ Spinal System implant can only be implanted via a Posterior (PLIF) approach. When using the 18mm Capstone Control™ Spinal System implant, a minimum of 2 implants are required per spinal level.

| Type of Use (Select one or both, as applicable) |
|-------------------------------------------------------------------------------------------------|
| <label><input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D)</label> |
| <label><input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C)</label> |

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## K190165 - 510(k) Summary

# MEDTRONIC Capstone Control™ Spinal System

### April 2019

| I. Submitter | Medtronic Sofamor Danek, USA Inc.<br>1800 Pyramid Place<br>Memphis, Tennessee 38132<br>Telephone: [phone]<br>Fax: [phone] |
|-----------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person | Justin O'Connor<br>Sr. Regulatory Affairs Specialist<br>Direct Telephone: [phone] |
| Date Prepared | April 2019 |
| II. Name of Device | Capstone Control™ Spinal System |
| Common Name | Intervertebral Body Fusion Device |
| Classification Name | Intervertebral Fusion Device with Bone Graft, Lumbar |
| Classification | Implants: Class II<br>Instrument Trials: Class II |
| Product Codes | MAX (21 CFR 888.3080) |
| III. Predicate Devices | Predicate 1 (Primary Predicate): Capstone Control™ Spinal<br>System - K171107 (S.E. 09/26/2017)<br>Predicate 2 (Additional Predicate): Capstone Control™ Spinal<br>System - K120368 (S.E. 04/09/2012)<br>Predicate 3 (Additional Predicate): Perimeter® Interbody<br>Fusion Device – K090353 (S.E. 08/29/2009)<br>Predicate 4 (Additional Predicate): Capstone® Spinal System -<br>K073291 (S.E. 04/24/2008) |
| IV. Description | The Capstone Control™ Spinal System consists of convex cages with a bullet nose and angular teeth. The implants are made of Polyetheretherketone. The cages also contain Unalloy Tantalum markers, which allow for radiographic visualization during the surgical procedure. The Capstone Control™ Interbody Fusion Devices are provided in various widths, heights, and lordosis, which can be inserted between two vertebral bodies to give support and correction during interbody fusion surgeries. The hollow geometry of the implants also allows the implants to be packed with autogenous bone graft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone. |
| V. Indications for Use | The Capstone Control™ Spinal System is intended to be used in spinal fusion procedures for patients diagnosed with Degenerative Disc Disease (DDD) at 1 or 2 contiguous levels from L2 to S1. DDD patients may also have up to Grade 1 spondylolisthesis or retrolisthesis at the involved levels. DDD is defined as discogenic back pain with degeneration of the disc confirmed by history and radiographic studies. When used for these indications, the Capstone Control™ Spinal System, is intended for use with supplemental fixation systems cleared for use in the lumbar spine.<br><br>Additionally, the Capstone Control™ Spinal System can be used to provide anterior column support in patients diagnosed with degenerative scoliosis as an adjunct to pedicle screw fixation.<br><br>These patients should be skeletally mature and have had 6 months of nonoperative treatment. The Capstone Control™ Spinal System is intended to be used with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft when the subject device is used as an adjunct to fusion. These implants may be implanted via an open or a minimally invasive posterior or transforaminal approach.<br><br>The 18mm Capstone Control™ Spinal System implant can only be implanted via a Posterior (PLIF) approach. When using the 18mm Capstone Control™ Spinal System implant, a minimum of 2 implants are required per spinal level. |
| VI. Comparison of<br>Technological | The subject CAPSTONE CONTROL™ Spinal System has the same intended use, indications, materials, technological characteristics, spinal location, surgical approach, and sterilization |
| Characteristics with<br>the Predicate Devices | method as its predicates. Both the subject and predicate Capstone<br>Control™ devices are based on the same technological<br>characteristics of providing fusion support for patients diagnosed<br>with Degenerative Disc Disease (DDD) at one to two contiguous<br>levels from L2 to S1, as well as used to provide anterior column<br>support in patients diagnosed with degenerative scoliosis as an<br>adjunct to pedicle screw fixation. The only difference between the<br>subject and predicate Capstone Control™ devices is the subject<br>devices have a length, which falls outside the cleared range of the<br>Capstone Control™ Spinal System but does not raise any issues of<br>safety and effectiveness. Please see the <b>Substantial Equivalence</b><br>section of this submission for more detail. |
| VII. Performance Data | <b>Mechanical Testing</b><br>In order to demonstrate substantial equivalence, Medtronic used to<br>following FDA guidance document: Class II Special Controls Guidance Document:<br>Intervertebral Body Fusion Device issued June 12, 2007 Design verification testing for the worst-case subject interbody<br>fusion device was completed in accordance with the following: ASTM F2077: Test Methods for Intervertebral Fusion<br>Devices ASTM F2267: Standard Test Method for Measuring Load<br>Induced Subsidence of Intervertebral Body Fusion Device<br>under Static Axial Compression The verification tests completed were the following: Static compression (ASTM F2077) Static compression-shear (ASTM F2077) Compression fatigue (ASTM F2077) Compression-shear fatigue (ASTM F2077) Subsidence (ASTM F2267) The acceptance criteria was met for all tests. Please see the<br><b>Bench Performance Testing</b> section of this submission for<br>more detail. |
| | Biocompatibility<br>Identical to the predicate devices, the sterile interbody fusion<br>devices in the subject devices are made of Polyetheretherketone<br>(PEEK) and contain Unalloy Tantalum markers, which allow for<br>radiographic visualization during the surgical procedure. The non-<br>sterile trials in the subject devices are manufactured from stainless<br>steel, which is identical to the material used to manufacture the<br>instruments cleared in the predicate devices. The materials<br>mentioned above are considered biocompatible due to their long<br>history of clinical use in medical devices. |
| | Bacterial Endotoxin Testing<br>The bacterial endotoxin test, also known as Limulus amebocyte<br>lysate (LAL) test, was performed utilizing worst case subject<br>interbody fusion devices to verify that the subject devices meet the<br>20 endotoxin units (EU)/device pyrogen limit specification.<br>Testing was successfully performed, and it was confirmed that the<br>subject devices meet the 20 EU/device testing limit for general<br>medical devices that are implanted as outlined in ANSI/AAMI<br>ST72, Bacterial endotoxins – Test methods, routine monitoring,<br>and alternatives to batch testing and USP <161>, Medical Devices<br>- Bacterial Endotoxin and Pyrogen Tests. |
| | Magnetic Resonance Imaging (MRI)<br>The subject interbody fusion devices are part of the Capstone<br>Control™ Spinal System that was cleared as MR-Conditional in<br>Primary Predicate 1 (K171107, S.E. 09/26/2017). In accordance<br>with the Guidance for Industry and FDA Staff - Establishing<br>Safety and Compatibility of Passive Implants in the Magnetic<br>Resonance (MR) Environment, Medtronic re-evaluated the MRI<br>compatibilty of the subject implants and determined that they do<br>not present a new worst case to the existing Capstone Control™<br>Spinal System. Therefore, the Capstone Control™ Spinal System<br>with the addition of the subject interbody fusion devices, remains<br>classified as MR-Conditional. |
| VIII. Conclusion | Based on the supporting evidence provided, Medtronic believes the<br>subject devices are substantially equivalent to the below predicates,<br>as well as, the 5th percentile of PLIF devices that have been cleared<br>by the FDA for market release. |

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| Predicate 1 (Primary Predicate): Capstone Control™<br>●<br>Spinal System - K171107 (S.E. 09/26/2017) |
|------------------------------------------------------------------------------------------------------------|
| Predicate 2 (Additional Predicate): Capstone Control™<br>●<br>Spinal System - K120368 (S.E. 04/09/2012) |
| Predicate 3 (Additional Predicate): Perimeter®<br>●<br>Interbody Fusion Device - K090353 (S.E. 08/29/2009) |
| Predicate 4 (Additional Predicate): Capstone® Spinal<br>●<br>System - K073291 (S.E. 04/24/2008) |

K190165 510k Summary Page 5 of 5