B5 has been updated to reflect the approximate surgical delay.Upon visual inspection it was noted that the cage was returned fractured in 2 pieces.The window supports were not returned with the rest of the cage.Device history records were reviewed for this lot, no relevant manufacturing issues were identified.The tritanium pl surgical technique guide (stg) indicates that a cage should be chosen which is equivalent to the final trial height or final distractor used.The implant sizing is based on the fit and feel of either the final trial or distractor.A corrective action/preventative action was opened to further investigate and prevent recurrence of tritanium pl cage fractures.The root cause was determined to be the user overestimating the strength of the implant or not following the surgical technique which recommends to distract prior to insertion and warning against the ¿twist & distract¿ method, inadequate disc prep, and lack of trailing.It was reported that the disc space was distracted using shavers only, trailing was not performed and the disc space was tight.No twist and distract was performed, just slight cantilevering and sweeping.It was considered a difficult angle at l5/s1 with no difficulty with impaction or insertion.Implant was not repositioned.Compression was not applied to the disc space after insertion.Bone quality and patient factors are unknown.All pieces were retrieved from the patient.Trailing is a step outlined in the tritanium pl stg.The stg also warns against cantilevering the implant during insertion.Most likely root cause is multifactorial with lack of trailing, disc space too tight for the implant size selected and cantilever force applied during insertion contributing to the event.
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