A 3D-printing process gives unprecedented design freedom. Multiple companies saw the opportunities this offers for spinal fusion and jumped on it. We validated the manufacturing route for 3D printing and designed multiple product lines of titanium 3D printed cages and accompanying instruments. We performed clinical evaluations, risk management, verification and validation and wrote documentation for the technical file. For some product lines BAAT is the legal manufacturer and handles operations, while for others we worked according to the customers quality management system and they got CE and FDA approval themselves.