Resident Johns Hopkins University - Department of Neurosurgery Johns Hopkins Hospital Baltimore, MD, US
Disclosure(s):
Jawad M. Khalifeh, MD: No financial relationships to disclose
Introduction: Surgical management of primary and metastatic spinal tumors has seen innovations in personalized therapeutics, minimally invasive techniques, and implant technology. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is an alternative to titanium-based instrumentation for spinal stabilization. Reductions in postoperative imaging artifacts improve radiation planning and follow-up imaging quality. We sought to report our institutional experience with CFR-PEEK implant technology in spinal oncologic patients.
Methods: This is a retrospective cohort study of all adult patients who underwent surgical intervention for primary or metastatic spinal tumors at a tertiary hospital between 2016 and 2024, using either titanium-only or ‘Hybrid’ CFR-PEEK and titanium instrumentation for stabilization. We compared demographics, preoperative and perioperative characteristics, and postoperative outcomes of overall survival (OS) and progression free survival (PFS).
Results: Eighty-two patients with 316 instrumented levels were included. Fifty-seven (69.5%) patients had Titanium instrumentation and 24 (29.2%) had CFR/PEEK instrumentation. Most tumors were metastatic (Titanium 49, 86% versus CFR-PEEK 18, 75%). Constructs were slightly longer in the Titanium (7.95 ±2.5 levels) than ‘CFR-PEEK’ (6.75 ±1 level) cohort, p=0.04. There were no differences in mean age (Titanium 63 ±11.8 years versus CFR-PEEK 61 ±18, p=0.8), sex (33 male, 58% versus 11, 46%, p=0.8), BMI (27 ±6 versus 26 ±4, p=0.4), and symptom duration (15 ±25 months versus 12 ±12, p=0.2). There were no differences in preoperative symptoms of back pain (Titanium 54, 95% versus CFR-PEEK 21, 87.5%, p=1), sensory deficit (18, 32% versus 5, 21%, p=0.423), and motor deficit (15, 26% versus 5, 21%, p=0.8). There were no differences in perioperative variables of CCI, ASA class, operative duration, and EBL. Sixty-six patients received postoperative radiotherapy with 56 (85%) patients receiving SBRT (Titanium 46/50, 92% versus CFR-PEEK 10/16, 63%, p=0.01). Follow-up was greater in the Titanium (28 ±23 months) than CFR-PEEK (6.5 ±5.5 months) cohort, p< 0.001. Local recurrence or progression occurred in 25 (30.4%) patients (Titanium 20, 35% versus CFR-PEEK 5, 21%, p=0.29), and mortality in 44 (54%) patients (34, 60% versus 10, 42%, p=0.14).
Conclusion : CFR-PEEK presents a reliable alternative to Titanium-based instrumentation in patients with primary and metastatic spinal tumors, with comparable perioperative and postoperative outcomes.