Background <p>The availability of evidence supporting the use of 3D-printed porous titanium interbody implants for lumbar spinal fusion varies by procedure and implant design, with relatively few reports to-date of patient outcomes in anterior lumbar interbody fusion (ALIF). This retrospective study aims to investigate the clinical and radiographic outcomes of an interfixated 3D-printed, porous titanium ALIF implant used to treat DDD, spondylolisthesis, degenerative scoliosis, and stenosis conditions.</p> Methods <p>A multicenter retrospective chart review of all patients who underwent ALIF surgery with the 3D-printed, porous titanium ALIF intervertebral cage for degenerative pathologies of the lumbar spine from 2020 to 2023 was performed. Patient demographics, surgical details, fusion status, complications data, and visual analog scale (VAS) back pain were collected and evaluated from all available patient records.</p> Results <p>A total of 114 patients were included with a total of 136 levels treated with the 3D-printed porous titanium ALIF cage. Patients were followed for an average of 19.7 months. The fusion rates of patients with assessable imaging data by 12 and 24 months postoperative were 99.0% (n = 100) and 98.2% (n = 110). There were 6 device-related complications in 6 patients (5.3%), with 4 interbody device-related complications (3.5%) attributable to loosening of interfixated screws (1.8%) and/or cage subsidence (2.6%), with one removal of the ALIF device (0.9%). At 6-month and 12-month follow-up, VAS back pain was improved by 56% (n = 43) and 41% (n = 24), respectively as compared to the preoperative VAS back pain scores.</p> Conclusions <p>The interfixated 3D-printed titanium ALIF cage resulted in a high fusion rate, significantly improved back pain, and low rates of device-related complications in a real-world, multicenter patient series. Future prospective, comparative studies are warranted to assess the relative safety, efficacy and value of differing cage designs.</p>