BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CD HORIZON SPINAL SYSTEM

    MDR report key: 9933898 · Received April 8, 2020

    Report

    Report Number
    1030489-2020-00428
    Event Type
    Injury
    Date Received
    April 8, 2020
    Report Date
    June 2, 2020
    Manufacturer
    WARSAW ORTHOPEDICS
    Product Code
    KWP
    PMA / PMN Number
    SEE H10
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 0

    MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 0

    ON (B)(6) 2020, A REVISION SURGERY WAS PERFORMED, IN WHICH EXTENSION OF FUSION WAS PERFORMED. THE SCREW AT L3, FROM WHICH THE ROD CAME OFF, WAS REPLACED. AS "AI" BACKED OUT TOTALLY AND CAME OFF TO THE POSTERIOR SIDE, "DD" WAS ALSO PLACED AT L3-L4 FROM THE ANTERIOR SIDE TO THE INTERVERTEBRAL DISC SPACE. ADDITIONAL SCREW INSERTION WAS PERFORMED AT L2. CONNECTION WAS PERFORMED USING CONNECTOR.

    Additional Manufacturer Narrative · 1

    THIS PART IS NOT APPROVED FOR USE IN THE UNITED STATES; HOWEVER A LIKE DEVICE CATALOG # 1555006100, 510K # K121680 AND UDI # (B)(4) WAS CLEARED IN THE UNITED STATES. NEITHER THE DEVICE NOR FILMS OF APPLICABLE IMAGING STUDIES WERE RETURNED TO THE MANUFACTURER FOR EVALUATION. THEREFORE, WE ARE UNABLE TO DETERMINE THE DEFINITIVE CAUSE OF THE REPORTED EVENT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT PRESENTED WITH LUMBAR SPINAL CANAL STENOSIS; AND UNDERWENT TRANSFORAMINAL LUMBAR INTERBODY FUSION AT L3-S1. ON AN UNKNOWN DATE, POST-OP, ON BOTH SIDES (THE LEFT SIDE AND THE RIGHT SIDE), THE RODS HAD DEVIATED FROM THE SCREWS AT L3 TO THE CAUDAL SIDE, BUT THE SET SCREWS REMAINED FITTED ON THE SCREWS. ADDITIONALLY, THE CAGE (THAT WAS IMPLANTED AT L3-L4) BACKED OUT FROM THE INTERVERTEBRAL DISC SPACE. REPORTEDLY, ALTHOUGH, A REVISION SURGERY HAD BEEN SCHEDULED FOR (B)(6) 2020 DUE TO POSTERIOR JUNCTIONAL KYPHOSIS, THE PATIENT DID NOT WANT TO UNDERGO A REVISION SURGERY. SO, THE REVISION SURGERY WOULD NOT BE PERFORMED CURRENTLY. THE SURGEON SUSPECTED THAT THE COMPRESSION LOOSENED DUE TO ROD DEVIATION, WHICH LED TO CAGE BACK-OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    400572 CD HORIZON SPINAL SYSTEM APPLIANCE, FIXATION, SPINAL INTERLAMINAL KWP WARSAW ORTHOPEDICS NA 0695301W

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention CAGE, ROD| CAGE, ROD