Composite PEEK/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series

Boriani, Stefano; Pipola, Valerio; Cecchinato, Riccardo; Ghermandi, Riccardo; Tedesco, Giuseppe; Fiore, Maria Rosaria; Dionisi, Francesco; Gasbarrini, A.

doi:10.1007/s00586-020-06534-0

Cited by 21 publications

(24 citation statements)

References 25 publications

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“…No intraoperative complications were noted, and postoperative RT was administered without alteration in planning. 6 The findings in this study also demonstrate the safety and feasibility of CFRP hardware, which has been shown in a limited number of previous studies.…”

Section: Clinical Series Demonstrating Feasibility Of Cfrp Hardwaresupporting

confidence: 81%

“…The authors also attributed early detection of 6 local recurrences to implant radiolucency. 3 In a third series, Boriani et al 6 described 6 cervical cases where a hybrid system made of carbon rods and screws coupled with subliminal polyester bands with titanium clamps was used to stabilize the cervical and cervicothoracic regions. No intraoperative complications were noted, and postoperative RT was administered without alteration in planning.…”

Section: Clinical Series Demonstrating Feasibility Of Cfrp Hardwarementioning

confidence: 99%

“…4 Furthermore, the scattering effect from titanium hardware can compromise the therapeutic effect of RT and lead to unwanted irradiation of neighboring healthy tissues, particularly when particles are used. 3,5,6 Artifacts from metallic implants also interfere with postoperative surveillance imaging, which are used to rule out disease progression. 3,7 Recently, carbon fiber-reinforced PEEK (CFRP) composite implants have garnered attention as an alternative to conventional titanium implants for spinal oncology patients.…”

mentioning

confidence: 99%

“…In the spine, screws, rods, plates, and vertebral body replacement CFRP implants have been described for use in the cervical, thoracic, and lumbar spine segments. 3,5,6,[11][12][13] Authors have previously highlighted the advantages of CFRP over titanium systems, including reduced amounts of imaging artifacts, more facile RT planning, and potentially greater safety and quality of radiotherapy. 3,5,6 However, the number of clinical papers on CFRP remains limited, and to our knowledge no clinical series has described greater than 40 patients stabilized with CFRP instrumentation.…”

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confidence: 99%

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Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes

Neal¹,

Richards²,

Curley³

et al. 2021

Neurosurgical Focus

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OBJECTIVE The authors aimed to demonstrate the feasibility and advantages of carbon fiber–reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. METHODS Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. RESULTS The study population included 14 females and 14 males with a mean age of 60 years (range 30–86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6–14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3–8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1–23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1–22 months). Eighteen patients received postoperative radiation at the authors’ institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CONCLUSIONS CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.

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Section: Clinical Series Demonstrating Feasibility Of Cfrp Hardwaresupporting

confidence: 81%

Section: Clinical Series Demonstrating Feasibility Of Cfrp Hardwarementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes

Neal¹,

Richards²,

Curley³

et al. 2021

Neurosurgical Focus

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“…These difficulties with radiotherapy planning along with the difficulty that instrumentation creates in executing effective radiographic follow-up have led some centers to consider the use of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation. 58,59 CFR-PEEK rods, unlike titanium rods, are radiolucent and so create minimal artifact on the CT scans employed for radiation planning. 60,61 Additionally, CFR-PEEK rods better approximate the elastic modulus of cortical bone.…”

Section: Instrumentation and Radiotherapymentioning

confidence: 99%

Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Pennington

Ehresman

Elsamadicy

et al. 2021

Neurosurgical Focus

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OBJECTIVE Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At many institutions, adjuvant radiation is recommended; definitive radiation is also recommended for the treatment of unresectable tumors. Because of the high off-target radiation toxicities associated with conventional radiotherapy, there has been growing interest in the use of proton and heavy-ion therapies. The aim of this study was to systematically review the literature regarding these therapies. METHODS The PubMed, OVID, Embase, and Web of Science databases were queried for articles describing the use of proton, combined proton/photon, or heavy-ion therapies for adjuvant or definitive radiotherapy in patients with primary sarcoma or chordoma of the mobile spine and sacrum. A qualitative synthesis of the results was performed, focusing on overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS); local control; and postradiation toxicities. RESULTS Of 595 unique articles, 64 underwent full-text screening and 38 were included in the final synthesis. All studies were level III or IV evidence with a high risk of bias; there was also significant overlap in the reported populations, with six centers accounting for roughly three-fourths of all reports. Five-year therapy outcomes were as follows: proton-only therapies, OS 67%–82%, PFS 31%–57%, and DFS 52%–62%; metastases occurred in 17%–18% and acute toxicities in 3%–100% of cases; combined proton/photon therapy, local control 62%–85%, OS 78%–87%, PFS 90%, and DFS 61%–72%; metastases occurred in 12%–14% and acute toxicities in 84%–100% of cases; and carbon ion therapy, local control 53%–100%, OS 52%–86%, PFS (only reported for 3 years) 48%–76%, and DFS 50%–53%; metastases occurred in 2%–39% and acute toxicities in 26%–48%. There were no studies directly comparing outcomes between photon and charged-particle therapies or comparing outcomes between radiation and surgical groups. CONCLUSIONS The current evidence for charged-particle therapies in the management of sarcomas of the spine and sacrum is limited. Preliminary evidence suggests that with these therapies local control and OS at 5 years are comparable among various charged-particle options and may be similar between those treated with definitive charged-particle therapy and historical surgical cohorts. Further research directly comparing charged-particle and photon-based therapies is necessary.

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Radiolucent implants in orthopedic oncology

Federico,

Trevino,

Zavras

et al. 2023

Journal of Surgical Oncology

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Radiolucent implants in have demonstrated promising results for both extremity and spine oncologic procedures. However, questions persist about whether the superiority in surveillance imaging justify the increased cost and technical challenges. In this review, we present the current body of literature for the use of radiolucent implants in musculoskeletal oncology, with a focus on implant complications, including screw loosening, breakage, malposition, and loss of reduction. We also discuss clinical outcomes, technical considerations, and postoperative radiotherapy.

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Composite PEEK/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series

Cited by 21 publications

References 25 publications

Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes

Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes

Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum

Radiolucent implants in orthopedic oncology

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