Unfold new spaces for fusion

Surgical flexibility in posterior stabilization procedures

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With the AESCULAP® 3D Cages we extend our spine platform by having designed a perfect partner for AESCULAP® Ennovate®: we offer you ONE solution for surgical flexibility in posterior stabilization procedures.
Interbody fusion remains an effective clinical treatment for a range of spinal disorders.
To achieve a successful fusion, good osseointegration properties and high mechanical stability of the implants are crucial.

That is exactly why we designed our 3D Cage family based on Structan® lattice structure and manufacture it with latest technology of laser sintering.

Innovative technology meets modern engineering

The technology of laser sintering

Additive manufacturing – 3D printing –means a layer-by-layer process to design a device using laser beam and metal powder. This innovative laser beam melting technology is of growing importance in the manufacture of implants, as it allows to create various fine and porous surface structures based on 3D-CAD data with the aim to support bone-ingrowth. Homogenous or heterogeneous lattice structures or combinations of various kinds of structures and surfaces are generally conceivable, which means a high degree of design freedom.

We combined our long-time experience in designing and manufacturing spinal implants with latest technology and produce in-house our AESCULAP® 3D Cages.

The lattice structure Structan®

AESCULAP® 3D Cages are engineered from Structan® – a lattice structure with largely isotropic behavior. Ti6Al4V ELI was chosen as a proven and biocompatible material for implants. [1]
Structan® features an all-over regular pore size and porosity in a favorable range to stimulate bone ingrowth. [2-7] Moreover the Young’s modulus of Structan® is developed to be close to that of cortical bone. [8] This may prevent subsidence into the vertebral body. [9] In addition, this may result in improved bone growth. [10] The elasticity combined with a high compressive strength contributes to high safety against failure due to breakage. [11-13]
The 3D cages are clearly visible in X-ray and CT and allow for full assessment of positioning and details of internal structure. [14,15]

All aspects are important for choosing an interbody fusion implant and Structan® is designed to deliver an attractive material choice for you.

AESCULAP® 3D Cage portfolio

The 3D cage portfolio comprises implants and instruments for ACDF, PLIF, TLIF and Oblique TLIF procedures depending on indication, treatment concept and your preference.

Unfold new spaces for fusion – Are you ready to explore more?

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[1] Ngoc Bich VU et al. In vitro and in vivo biocompatibility of Ti-6Al-4V titanium alloy and UHMWPE polymer for total hip replacement. Biomedical Research and Therapy. 2016;3(3):567-77.
[2] Van der Stok J, Van der Jagt O, Yavari S, De Haas M, WaarsingJ, Jahr H et al. Selective laser meltingproduced porous titanium scaffolds regenerate bone in critical size cortical bone defects. Journal of Orthopaedic Research. 2013;31(5):792–9.
[3] In vivo study of porous metallic lattice structures, Ulm, 2011. The biocompatibility, osseointegration and biomechanical properties of porous Ti6Al4V implants manufactured by SLM were tested under mechanical loading conditions in an ovine model study sponsored by Aesculap AG. The samples were evaluated histologically and biomechanically after implantation. Porous Ti6Al4V implants exhibited very good biocompatibility, bone-implant interface strength and osseointegration. Six months after implantation, bone ingrowth on and into the porous Ti6Al4V implants was reported. Inflammatory reactions that may influence bone formation were not observed.
[4] Karageorgiou V, Kaplan D. Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials. 2005;26(27):5474-91.
(5] Taniguchi N et al. Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: an in vivo experiment. Materials Science and Engineering: C. 2016;59:690-701.
[6] Van Bael S et al. The effect of pore geometry on the in vitro biological behavior of human periosteum-derived cells seeded on selective laser-melted Ti6Al4V bone scaffolds. Acta biomaterialia. 2012;8(7):2824-34.
[7] Elias CN et al. Mechanical and clinical properties of titanium and titanium-based alloys (Ti G2, Ti G4 cold worked nanostructured and Ti G5) for biomedical applications. Journal of Materials Research and Technology. 2019;8(1):1060-9.
[8] Internal Report U-0464/19: Product Qualification Validation of Aesculap 3D Cages lattice structure, Tuttlingen, 2019. In the scope of a product-related PQ validation, test specimens were manufactured with a lattice structure corresponding to the Aesculap 3D Cages. Subsequently, the strength was determined by a static compression test, the microstructure by a structural analysis as well as the dimensional accuracy by measuring the lattice struts. The investigated lattice test specimens totally satisfied the acceptance criteria in terms of lattice dimensions, strength and microstructure.
[9] Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J. 2013;22(7):1539–46.
[10] Brizuela A, et al. Influence of the elastic modulus on the Osseointegration of Dental Implants. Materials. 2019;12(6):980.
[11] Azami M, Moztarzadeh F, Tahriri M. Preparation, characterization and mechanical properties of controlled porous gelatin / hydroxyapatite nanocomposite through layer solvent casting combined with freeze-drying and lamination techniques. Journal of Porous Materials. 2010;17(3):313-20.
[12] Rae PJ, Brown EN, Orler EB. The mechanical properties of poly (ether-ether-ketone) (PEEK) with emphasis on the large compressive strain response. Polymer. 2007;48(2):598-615.
[13] Internal Report U-0246/19: Equivalence test on 3D Cages, compressive specimens with 3D Cage lattice structure and standard tensile specimens, Tuttlingen, 2019.
[14] Usability-Test, Usability Validation of AESCULAP® PROSPACE® 3D Oblique Cages, Tubingen, 2019. The usability of the AESCULAP® 3D Cage System PROSPACE® 3D Oblique was tested in April 2019, in a cadaver workshop with six independent test persons as intended users (surgeons specialized in spinal surgery or comparable fields). Parameters such as implant visibility under x-ray control, mechanical stability of the implant/instrument interface and implant surface evaluation in terms of tissue injury risk were tested among others. Acceptance criteria were fulfilled for all the above-mentioned parameters. All test users confirmed the absence of critical features that must be improved prior to clinical use.
[15] Rehnitz, Christoph, PD Dr. med. Radiological image evaluation of AESCULAP® interbody fusion devices, Heidelberg, 2019. CT and X-ray visualization of different AESCULAP® interbody fusion cages (full titanium, porous Ti6Al4V and PLASMAPORE®XP cages) was tested in a cadaver setup. A radiologist evaluated the implant visibility and the presence of artefacts that may limit the visualization of adjacent structures. Visualization and assessment of implant position was achieved in X-ray and CT for all tested cages. Minor artefacts were visible in CT reconstructions in the surrounding of porous Ti6Al4V and full titanium implants. Porous Ti6Al4V implants showed slightly fewer artefacts in CT in comparison to full titanium implants. The minor artefacts observed did not limit the assessment of the surrounding anatomical structures.

For further information please contact your Aesculap representative or mail to
Aesculap AG
Am Aesculap-Platz
78532 Tuttlingen