Tritanium® TL Curved Posterior Lumbar Cage

K173476 · Stryker · MAX · Jan 18, 2018 · Orthopedic

Device Facts

• Record ID: K173476
• Device Name: Tritanium® TL Curved Posterior Lumbar Cage
• Applicant: Stryker
• Product Code: MAX · Orthopedic
• Decision Date: Jan 18, 2018
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 888.3080
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Stryker Spine Tritanium® TL cage is an intervertebral body fusion device indicated for use with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft when used as an adjunct to fusion in patients with degenerative disc disease (DDD) at one level or two contiguous levels from L2 to S1. DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. The DDD patients may also have up to Grade I spondylolisthesis at the involved level(s). These patients should be skeletally mature and have six months of nonoperative therapy. Additionally, the Tritanium TL Cage can be used as an adjunct to fusion in patients diagnosed with degenerative scoliosis. The Tritanium TL Cage is to be implanted via a posterior approach. The Tritanium TL Cage is intended to be used with supplemental spinal fixation systems that have been cleared for use in the lumbosacral spine.

Device Story

Curved intervertebral body fusion cage; implanted via posterior approach; used as adjunct to fusion in lumbar spine. Device features solid and porous structures created via Laser Rapid Manufacturing (LRM) using proprietary Tritanium In-Growth Technology. Serrated superior/inferior surfaces provide multidirectional fixation and maximize endplate contact; tapered leading edge facilitates insertion; central column allows for graft containment. Used by surgeons in clinical settings; requires supplemental spinal fixation systems. Provides structural support to intervertebral space to facilitate fusion; benefits patients by stabilizing spinal segments affected by degenerative disc disease or scoliosis.

Clinical Evidence

Bench testing only. No clinical data provided. Mechanical testing performed per ASTM F2077-14 (compression, shear, torsion), ASTM F04-25-02-02 (expulsion), and ASTM F2267-04 (subsidence). Material characterization and porous surface testing performed per ASTM F1472-08, F1147-05, F1044-05, F1160-05, E8/E8M, and F2129-15. Bacterial endotoxin testing performed per ANSI/AAMI ST72:2011.

Technological Characteristics

Constructed from Ti-6Al-4V titanium alloy (ASTM F1472-08). Manufactured via Laser Rapid Manufacturing (LRM). Features porous and solid structures. Provided sterile. Dimensions include various lengths, heights, and lordotic angles. Designed for use with supplemental fixation.

Indications for Use

Indicated for skeletally mature patients with degenerative disc disease (DDD) at one or two contiguous levels (L2-S1) or degenerative scoliosis. DDD defined as discogenic back pain with radiographic confirmation; may include up to Grade I spondylolisthesis. Requires six months of failed nonoperative therapy. Used with autograft/allogenic bone graft and supplemental spinal fixation.

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

• AVS® PL and TL PEEK Spacers (K151726)
• Tritanium® PL Posterior Lumbar Cage (K162262)
• Tritanium® C Anterior Cervical Cage (K171496)

Submission Summary (Full Text)

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January 18, 2018

Stryker Mr. Nikin Desai Regulatory Affairs Specialist 2 Pearl Court Allendale, New Jersey 07401

Re: K173476

Trade/Device Name: Tritanium® TL Curved Posterior Lumbar Cage Regulation Number: 21 CFR 888,3080 Regulation Name: Intervertebral Body Fusion Device Regulatory Class: Class II Product Code: MAX Dated: November 8, 2017 Received: November 9, 2017

Dear Mr. Desai:

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 of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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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.

For comprehensive regulatory information about medical devices and radiation-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,

### Katherine D. Kavlock -S

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

Enclosure

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### Indications for Use

510(k) Number (if known) K173476

Device Name

Tritanium® TL Curved Posterior Lumbar Cage

#### Indications for Use (Describe)

The Stryker Spine Tritanium® TL cage is an intervertebral body fusion device indicated for use with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft when used as an adjunct to fusion in patients with degenerative disc disease (DDD) at one level or two contiguous levels from L2 to S1.

DDD is defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies. The DDD patients may also have up to Grade I spondylolisthesis at the involved level(s). These patients should be skeletally mature and have six months of nonoperative therapy.

Additionally, the Tritanium TL Cage can be used as an adjunct to fusion in patients diagnosed with degenerative scoliosis.

The Tritanium TL Cage is to be implanted via a posterior approach.

The Tritanium TL Cage is intended to be used with supplemental spinal fixation systems that have been cleared for use in the lumbosacral spine.

| Type of Use (Select one or both, as applicable) |
|-----------------------------------------------------------------------------------------|
| <span style="font-family: Arial;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D) |
| ☐ Over-The-Counter Use (21 CFR 801 Subpart C) |

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# stryker

| 510(k) Summary: Tritanium® TL Curved Posterior Lumbar Cage | |
|------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Manufacturer/Submitter: | Stryker Spine<br>2 Pearl Ct.<br>Allendale, NJ 07401 |
| Contact Person : | Name: Nikin Desai<br>Phone: [phone]<br>Fax: [phone]<br>Email:[e-mail] |
| Date Prepared: | 11/08/2017 |
| Trade Name: | Tritanium® TL Curved Posterior Lumbar Cage |
| Common Name: | Intervertebral body fusion device |
| Proposed Class: | Class II |
| Classification Name: | Intervertebral Body Fusion Device with Bone Graft, Lumbar (21 CFR<br>§888.3080) |
| Product Code: | MAX |
| Predicate Devices: | Primary Predicates:<br>AVS® PL and TL PEEK Spacers (K151726)<br>Additional Predicates:<br>Tritanium® PL Posterior Lumbar Cage (K162262)<br>Tritanium® C Anterior Cervical Cage (K171496) |
| Device Description: | The purpose of this submission is to introduce a curved posterior lumbar<br>cage intended for use as an aid in lumbar spinal fixation.<br><br>The Tritanium TL Intervertebral Body Fusion Cage is intended for use as an<br>aid in lumbar spinal fixation. The cage is a curved implant that consists of a<br>unique configuration of both solid and porous structures that are<br>simultaneously built using Laser Rapid Manufacturing (LRM) method<br>applying Stryker's proprietary Tritanium® In-Growth Technology. The cage<br>is offered in a variety of lengths, heights and lordotic angles to adapt to a<br>variety of patient anatomies. It has serrations on the superior and inferior<br>surfaces designed for multidirectional fixation and to maximize surface area<br>for endplate contact with the implant. The implants have a smooth, tapered<br>leading edge to facilitate cage insertion into the intervertebral space. The<br>implants have a central column spanning endplate to endplate for graft<br>containment and to aid in fusion throughout the interbody cage.<br><br>The implant is designed to be used with supplemental fixation cleared for use<br>in the lumbosacral spine.<br><br>The Tritanium TL cages are constructed from Titanium alloy: Ti-6Al-4V<br>(ASTM F1472-08) and are provided sterile. |
| 510(k) Summary: Tritanium® TL Curved Posterior Lumbar Cage | |
| Indications for Use: | The Stryker Spine Tritanium® TL cage is an intervertebral body fusion device<br>indicated for use with autograft and/or allogenic bone graft comprised of<br>cancellous and/or corticocancellous bone graft when used as an adjunct to<br>fusion in patients with degenerative disc disease (DDD) at one level or two<br>contiguous levels from L2 to S1.<br><br>DDD is defined as back pain of discogenic origin with degeneration of the disc<br>confirmed by history and radiographic studies. The DDD patients may also<br>have up to Grade I spondylolisthesis at the involved level(s). These patients<br>should be skeletally mature and have six months of nonoperative therapy.<br><br>Additionally, the Tritanium TL Cage can be used as an adjunct to fusion in<br>patients diagnosed with degenerative scoliosis.<br><br>The Tritanium TL Cage is to be implanted via a posterior approach.<br><br>The Tritanium TL Cage is intended to be used with supplemental spinal<br>fixation systems that have been cleared for use in the lumbosacral spine. |
| Summary of the<br>Technological<br>Characteristics | The Subject Tritanium TL Curved Posterior Lumbar Cage and the cleared<br>Tritanium PL and C cages share similar material/material technology and<br>the following design features:<br>Graft windows for packing autogenous or allogenic bone Comparable heights, widths, lengths and lordotic angles Serrations on the superior and inferior surfaces Supplemental fixation |
| Summary of the<br>Performance Data | Testing in compliance with:<br><br>FDA's June 12, 2007 "Class II Special Controls Guidance Document:<br>Intervertebral Body Fusion Device" was performed for the subject Tritanium<br>TL Cages and demonstrated substantially equivalent performance to the<br>identified predicate devices. The following mechanical tests were performed:<br>Static and Dynamic Compression (per ASTM F2077-14) Static and Dynamic Compression Shear (per ASTM F2077-14) Static and Dynamic Torsion (per ASTM F2077-14) Expulsion (per ASTM F04-25-02-02 Draft) Subsidence (per ASTM F2267-04(2011)) Wear Debris Assessment, and Impaction<br>Characterization of the Physical, Chemistry and Mechanical properties of the<br>subject Tritanium TL Curved Posterior Lumbar Cage was established through |
| 510(k) Summary: Tritanium® TL Curved Posterior Lumbar Cage | |
| | Tritanium C Anterior Cervical Cage material testing which demonstrated that<br>the porous surface design of the cage met at minimum the requirements<br>outlined in the:<br>FDA guidance documents: "Guidance Document for testing orthopedic<br>implants with modified metallic surfaces apposing bone or bone<br>cement [April 28, 1994]", "Class II Special Controls Guidance<br>Document: Knee Joint Patellofemorotibial and Femorotibial<br>Metal/Polymer Porous-Coated Uncemented Prostheses [January 16,<br>2003]", and draft guidance for "Technical considerations for Additive<br>Manufactured Devices [May 10, 2016]" ASTM 1472-08: Standard Specification for Wrought Titanium-<br>6Aluminum-4Vanadium Alloy (UNS R56400) for Surgical Implant<br>Applications ASTM F1147-05: Standard Test Method for Tension Testing of<br>Calcium Phosphate and Metallic Coatings ASTM F1044-05: Standard Test Method for Shear Testing of Calcium<br>Phosphate and Metallic Coatings ASTM F1160-05: Standard Test Method for Shear and Bending<br>Fatigue Testing of Calcium Phosphate and Metallic Medical and<br>Composite Calcium Phosphate/Metallic Coating ASTM E8/E8M: Standard Test Methods for Tension Testing of Metallic<br>Materials Electromechanical performance evaluation of additive manufactured Ti-6Al-<br>4V alloy was also performed per ASTM F2129-15: Standard test method for<br>conducting cyclic potentiodynamic polarization measurements to determine<br>the corrosion susceptibility of small implant devices.<br>Bacterial endotoxin testing (BET) as specified in ANSI/AAMI<br>ST72:2011 is used for pyrogenicity testing to achieve the<br>Endotoxin limit of < 20EU/Device. |
| Conclusion | Based on the design features, the use of established well known materials,<br>feature comparisons, indications for use, and results of the mechanical<br>testing, the Tritanium TL Curved Posterior Lumbar Cage has demonstrated<br>substantial equivalence to the identified predicate devices |

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## stryker