{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T18:42:15Z","timestamp":1794336135008,"version":"4.9.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>By minimizing imaging artifact and particle scatter, carbon fiber\u2013reinforced polyetheretherketone (CF-PEEK) spinal implants are hypothesized to enhance radiotherapy (RT) planning\/dosing and improve oncological outcomes. However, robust clinical studies comparing tumor surgery outcomes between CF-PEEK and traditional metallic implants are lacking. In this paper, the authors performed a systematic review of the literature with the aim to describe clinical outcomes in patients with spine tumors who received CF-PEEK implants, focusing on implant-related complications and oncological outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A systematic review of the literature published between database inception and May 2022 was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PubMed database was queried using the terms \"carbon fiber\" and \"spine\" or \"spinal.\" The inclusion criteria were articles that described patients with CF-PEEK pedicle screw fixation and had a minimum of 5 patients. Case reports and phantom studies were excluded.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>This review included 11 articles with 326 patients (237 with CF-PEEK\u2013based implants and 89 with titanium-based implants). The mean follow-up period was 13.5 months, and most tumors were metastatic (67.1%). The rates of implant-related complications in the CF-PEEK and titanium groups were 7.8% and 4.7%, respectively. The rate of pedicle screw fracture was 1.7% in the CF-PEEK group and 2.4% in the titanium group. The rates of reoperation were 5.7% (with 60.0% because of implant failure or junctional kyphosis) and 4.8% (all because of implant failure or junctional kyphosis) in the CF-PEEK and titanium groups, respectively. When reported, 72.5% of patients received postoperative RT (41.0% stereotactic body RT, 30.8% fractionated RT, 25.6% proton, 2.6% carbon ion). Four articles suggested that implant artifact was reduced in the CF-PEEK group. Local recurrence occurred in 14.4% of CF-PEEK and 10.7% of titanium-implanted patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>While CF-PEEK harbors similar implant failure rates to traditional metallic implants with reduced imaging artifact, it remains unclear whether CF-PEEK implants improve oncological outcomes. This study highlights the need for prospective, direct comparative clinical studies.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine23106","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T23:05:09Z","timestamp":1687647909000},"page":"534-547","source":"Crossref","is-referenced-by-count":35,"title":["Carbon fiber\u2013reinforced PEEK spinal implants for primary and metastatic spine tumors: a systematic review on implant complications and radiotherapy benefits"],"prefix":"10.3171","volume":"39","author":[{"given":"Hammad A.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roee","family":"Ber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean N.","family":"Neifert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Kurland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpit","family":"Chhabra","sequence":"additional","affiliation":[{"name":"New York Proton Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony K.","family":"Frempong-Boadu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Phys Med Biol","first-page":"111","article-title":"The calibration of CT Hounsfield units for radiotherapy treatment planning","volume":"41","author":"Schneider U","year":"1996","unstructured":"Schneider U, Pedroni E, Lomax A. 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J Clin Neurosci. 2017;45:166\u2013171."},{"issue":"4","key":"b34","series-title":"J Neurosurg Spine","first-page":"665","article-title":"Survival, fusion, and hardware failure after surgery for spinal metastatic disease","volume":"34","author":"Yee TJ","year":"2021","unstructured":"Yee TJ, Saadeh YS, Strong MJ,  Survival, fusion, and hardware failure after surgery for spinal metastatic disease. J Neurosurg Spine. 2021;34(4):665\u2013672."},{"issue":"2","key":"b35","series-title":"J Surg Oncol","first-page":"115","article-title":"Long-term results of Phase II study of high dose photon\/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas","volume":"110","author":"DeLaney TF","year":"2014","unstructured":"DeLaney TF, Liebsch NJ, Pedlow FX,  Long-term results of Phase II study of high dose photon\/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. 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Int J Radiat Oncol Biol Phys. 2016;95(1):297\u2013303."},{"issue":"10","key":"b38","series-title":"Neuro Oncol","first-page":"1413","article-title":"Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy","volume":"15","author":"Al-Omair A","year":"2013","unstructured":"Al-Omair A, Masucci L, Masson-Cote L,  Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol. 2013;15(10):1413\u20131419."},{"issue":"2","key":"b39","series-title":"Int J Radiat Oncol Biol Phys","first-page":"261","article-title":"A phase 2 study of post-operative stereotactic body radiation therapy (SBRT) for solid tumor spine metastases","volume":"106","author":"Redmond KJ","year":"2020","unstructured":"Redmond KJ, Sciubba D, Khan M,  A phase 2 study of post-operative stereotactic body radiation therapy (SBRT) for solid tumor spine metastases. Int J Radiat Oncol Biol Phys. 2020;106(2):261\u2013268."},{"issue":"3","key":"b40","series-title":"Spine (Phila Pa 1976)","first-page":"252","article-title":"Integrated custom composite polyetheretherketone\/carbon fiber (PEEK\/CF) vertebral body replacement (VBR) in the treatment of bone tumors of the spine: a preliminary report from a multicenter study","volume":"47","author":"Shen FH","year":"2022","unstructured":"Shen FH, Gasbarrini A, Lui DF, Reynolds J, Capua J, Boriani S. Integrated custom composite polyetheretherketone\/carbon fiber (PEEK\/CF) vertebral body replacement (VBR) in the treatment of bone tumors of the spine: a preliminary report from a multicenter study. 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