MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC STEALTHSTATION® S7¿ NEUROLOGICAL STEREOTAXIC INSTRUMENT

Model Number 9733857

Device Problem Imprecision (1307)

Patient Problems Bone Fracture(s) (1870); Muscle Weakness (1967); Pain (1994); Numbness (2415); Insufficient Information (4580)

Event Date 08/24/2021

Event Type  Injury  

Manufacturer Narrative

Patient information was not included in the journal entry age or date of birth: this value reflects the average age of the patients who underwent the lateral single-position surgery as specific patients could not be identified. This value reflects the majority gender of the patients who underwent the lateral single-position surgery as specific patients could not be identified. Sex: the article did not provide the date of the procedure. The event date provided is the accepted date. The article citation is included. Brand name. The unknown navigation system represents a version of the s7. The serial number was not provided in the journal article. Udi not available for this system. No 510k provided as system is unknown. No evaluation was performed as the event was reported as a literature article. Device manufacturing date is unavailable. If information is provided in the future, a supplemental report will be issued.

Event Description

Hiyama, akihiko, et al. ¿intraoperative computed tomography-guided navigation versus fluoroscopy for single-position surgery after lateral lumbar interbody fusion. ¿ journal of clinical neuroscience, vol. 93, 2021, pp. 75¿81. , https://doi. Org/10. 1016/j. Jocn. 2021. 08. 023. Summary there are no reports comparing fluoroscopy and intraoperative computed tomography (ct) navigation in lateral single-position surgery (sps) in terms of surgical outcomes or implant-related complications. Therefore, the purpose of this study was to use radiological evaluation to compare the incidence of instrument-related complications in sps of lateral lumbar interbody fusion (llif) using fluoroscopy with that using ct navigation techniques. We evaluated 99 patients who underwent lateral sps. Twenty-six patients had a percutaneous pedicle screw (pps) inserted under fluoroscopy (sps-c group), and 73 patients had a pps inserted under intraoperative ct navigation (sps-o group). Average operation time was shorter in the sps-c group than in the sps-o group (88. 4 ± 24. 4 min versus 111. 9 ± 35. 3 min, respectively, p
=
0. 003). However, there was no significant difference between the two groups in postoperative thigh symptoms or reoperation rate. The screw insertion angle of the sps-c group was smaller than that of the sps-o group, but there was no significant difference in the rate of screw misplacement (4. 6% versus 3. 4%, respectively, p
=
0. 556). By contrast, facet joint violation (fjv) was significantly lower in the sps-o group than in the sps-c group (8. 4% versus 21. 3%, respectively, p < 0. 001). While fluoroscopy was superior to intraoperative ct navigation in terms of mean surgery time, there was no significant difference in the accuracy of pps insertion between fluoroscopy and intraoperative ct navigation. The advantage of intraoperative ct navigation over fluoroscopy is that it significantly decreases the occurrence of fjv in sps. Reported events: 73 patients with lumbar degenerative disc disease and degenerative lumbar spondylolisthesis underwent lateral single-position surgery. Among these patients ten were found have motor weakness and 14 reported thigh pain and numbness. In regards to screw misplacement, two screws were found to breach less than two millimeters, five screws breached between two and four millimeters, and two screws breached to the extent that they caused patient complications. The article sites that these complication could be things such as a fractured pedicle, an anterior breach with neurovascular compromise, and a lateral/medial breach with neurological sequelae. It was unclear from the article what complications were associated with each screw. Eighteen screw heads were in contact/suspected to be in contact with the facet joint, while seven screws invaded the facet joint. There were five reoperations, three being due to instrument related complications such as pps deviation and cage malposition.

• Brand Name: STEALTHSTATION® S7¿
• Type of Device: NEUROLOGICAL STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• Manufacturer (Section G): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• Manufacturer Contact: glen belmer ; 7000 central avenue ne rcw215; minneapolis, MN 55432 ; 6122713209
• MDR Report Key: 12814852
• MDR Text Key: 281837239
• Report Number: 1723170-2021-02695
• Device Sequence Number: 1
• Product Code: HAW
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K050438
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Literature,Health Professional

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 04/01/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/15/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes

Device Operator

• Device Model Number: 9733857
• Device Catalogue Number: 9733857
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 03/17/2022
• Was Device Evaluated by Manufacturer?: No
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse

Patient Treatment Data

Date Received: 11/15/2021 Patient Sequence Number: 1