{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:43:14Z","timestamp":1785422594994,"version":"3.56.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Metastatic spine disease significantly impacts the oncological population, often requiring surgical intervention to address spinal instability. Traditional constructs, including titanium-based long-segment instrumentation and short-segment cement augmentation, have been the mainstay in managing these patients. Carbon fiber\u2013reinforced polyetheretherketone (CFR-PEEK) hardware and shorter-segment instrumentation have demonstrated benefits of improved surveillance, earlier recurrence detection, and shorter operative time. This study evaluated the long-term experience of a single center with CFR-PEEK constructs in patients with metastatic spine disease. It also investigated the clinical durability of short-segment constructs and evaluated the necessity of cement augmentation in maintaining construct stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective, single-center study included patients with metastatic disease to the spine who underwent surgical fixation using CFR-PEEK hardware between 2021 and 2024. Inclusion criteria required perioperative radiation therapy and a minimum of 6 months of radiographic follow-up. Patients were stratified into short-construct (n = 13) and long-construct (n = 7) groups based on the number of vertebral levels spanned. Subgroup analysis of cement-augmented versus nonaugmented short constructs was performed. Variables analyzed included preoperative scores (American Spinal Injury Association grade, Karnofsky Performance Scale score, Spine Instability Neoplastic Score, and epidural spinal cord compression grade), estimated blood loss, length of hospital stay, and postoperative outcomes. Radiographic failure and revision surgery rates were primary endpoints. Statistical analyses were conducted using nonparametric methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At 14 months of mean follow-up time, no radiographic failures or revision surgeries were observed within the 20 patients included in this study. Patients in the long-construct group had more vertebral levels involved (2.00 vs 1.15, p = 0.024), lower preoperative Karnofsky Performance Scale scores (58.57 vs 76.15, p = 0.01), and more frequent use of mixed constructs with titanium rods (p = 0.007). Short constructs demonstrated equivalent durability without the routine need for cement augmentation. Within the short-construct cohort, cement augmentation was associated with longer hospital stays (8.8 vs 3.63 days, p = 0.008) but did not reduce failure rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>CFR-PEEK instrumentation demonstrates excellent durability and stability in metastatic spine disease, even in patients receiving perioperative radiation therapy. Short-segment instrumentation demonstrates comparable durability to long-segment constructs while reducing operative risks and hospitalization duration. While cement augmentation has traditionally been used to enhance construct strength, the findings in this study suggest that its routine use may not be necessary in short-segment constructs; however, larger studies are needed to better understand long-term outcomes, optimize construct selection, and identify factors influencing hardware failure in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24995","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:49Z","timestamp":1746081589000},"page":"E11","source":"Crossref","is-referenced-by-count":8,"title":["Evaluating long-term construct stability in metastatic spine cancer patients with carbon fiber\u2013reinforced polyetheretherketone instrumentation"],"prefix":"10.3171","volume":"58","author":[{"given":"Gavril","family":"Rosoklija","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skanda","family":"Sai","sequence":"additional","affiliation":[{"name":"Albany Medical College, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett Q.","family":"Barr","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Meleis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Oper Neurosurg (Hagerstown)","first-page":"310","article-title":"Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery","volume":"16","author":"Barzilai O","year":"2019","unstructured":"Barzilai O, Laufer I, Robin A, Xu R, Yamada Y, Bilsky MH. Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery. Oper Neurosurg (Hagerstown). 2019;16(3):310\u2013318."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"473","article-title":"Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases","volume":"38","author":"Chakravarthy VB","year":"2023","unstructured":"Chakravarthy VB, Hussain I, Laufer I,  Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases. J Neurosurg Spine. 2023;38(4):473\u2013480."},{"issue":"5","key":"b3","series-title":"Int Orthop","first-page":"309","article-title":"The incidence of vertebral body metastases","volume":"19","author":"Ortiz G\u00f3mez JA","year":"1995","unstructured":"Ortiz G\u00f3mez JA. The incidence of vertebral body metastases. Int Orthop. 1995;19(5):309\u2013311."},{"issue":"6","key":"b4","series-title":"Oncologist","first-page":"744","article-title":"The NOMS framework: approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Rubin DG, Lis E,  The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744\u2013751."},{"issue":"2","key":"b5","series-title":"Neurosurg Clin N Am","first-page":"151","article-title":"Neurologic, oncologic, mechanical, and systemic and other decision frameworks for spinal disease","volume":"31","author":"Newman WC","year":"2020","unstructured":"Newman WC, Laufer I, Bilsky MH. Neurologic, oncologic, mechanical, and systemic and other decision frameworks for spinal disease. Neurosurg Clin N Am. 2020;31(2):151\u2013166."},{"issue":"22","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"E1221","article-title":"A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher CG","year":"2010","unstructured":"Fisher CG, DiPaola CP, Ryken TC,  A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221\u2013E1229."},{"issue":"3","key":"b7","series-title":"J Spine Surg","first-page":"323","article-title":"Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors","volume":"3","author":"Tedesco G","year":"2017","unstructured":"Tedesco G, Gasbarrini A, Bandiera S, Ghermandi R, Boriani S. Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors. J Spine Surg. 2017;3(3):323\u2013329."},{"key":"b8","series-title":"World Neurosurg","first-page":"61","article-title":"Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations","volume":"152","author":"Takayanagi A","year":"2021","unstructured":"Takayanagi A, Siddiqi I, Ghanchi H,  Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations. World Neurosurg. 2021;152:61\u201370."},{"issue":"8","key":"b9","series-title":"J Appl Clin Med Phys","first-page":"6","article-title":"The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems","volume":"21","author":"M\u00fcller BS","year":"2020","unstructured":"M\u00fcller BS, Ryang YM, Oechsner M,  The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems. J Appl Clin Med Phys. 2020;21(8):6\u201314."},{"issue":"5","key":"b10","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur?","volume":"50","author":"Meleis A","year":"2021","unstructured":"Meleis A, Larkin MB, Bastos DCA,  Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur?. Neurosurg Focus. 2021;50(5):E9."},{"issue":"8","key":"b11","series-title":"Clin Spine Surg","first-page":"E1015","article-title":"Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach","volume":"30","author":"Kumar N","year":"2017","unstructured":"Kumar N, Malhotra R, Maharajan K,  Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg. 2017;30(8):E1015\u2013E1021."},{"key":"b12","series-title":"World J Surg Oncol","first-page":"68","article-title":"Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review","volume":"13","author":"Yang Z","year":"2015","unstructured":"Yang Z, Yang Y, Zhang Y,  Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review. World J Surg Oncol. 2015;13:68."},{"issue":"5","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"593","article-title":"Utility of cement augmentation via percutaneous fenestrated pedicle screws for stabilization of cancer-related spinal instability","volume":"16","author":"Barzilai O","year":"2019","unstructured":"Barzilai O, McLaughlin L, Lis E, Reiner AS, Bilsky MH, Laufer I. Utility of cement augmentation via percutaneous fenestrated pedicle screws for stabilization of cancer-related spinal instability. Oper Neurosurg (Hagerstown). 2019;16(5):593\u2013599."},{"issue":"7","key":"b14","series-title":"Spine J","first-page":"1609","article-title":"Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability","volume":"15","author":"Moussazadeh N","year":"2015","unstructured":"Moussazadeh N, Rubin DG, McLaughlin L, Lis E, Bilsky MH, Laufer I. Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability. Spine J. 2015;15(7):1609\u20131617."},{"issue":"1","key":"b15","series-title":"Neurospine","first-page":"84","article-title":"Hardware failure in spinal tumor surgery: a hallmark of longer survival?","volume":"19","author":"Zaborovskii N","year":"2022","unstructured":"Zaborovskii N, Schlauch A, Ptashnikov D,  Hardware failure in spinal tumor surgery: a hallmark of longer survival?. Neurospine. 2022;19(1):84\u201395."},{"key":"b16","series-title":"J Clin Neurosci","first-page":"166","article-title":"Hardware failure in patients with metastatic cancer to the spine","volume":"45","author":"Pedreira R","year":"2017","unstructured":"Pedreira R, Abu-Bonsrah N, Karim Ahmed A,  Hardware failure in patients with metastatic cancer to the spine. J Clin Neurosci. 2017;45:166\u2013171."},{"issue":"12","key":"b17","series-title":"Eur Spine J","first-page":"3229","article-title":"Composite PEEK\/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series","volume":"29","author":"Boriani S","year":"2020","unstructured":"Boriani S, Pipola V, Cecchinato R,  Composite PEEK\/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series. Eur Spine J. 2020;29(12):3229\u20133236."},{"issue":"4","key":"b18","series-title":"Eur Spine J","first-page":"874","article-title":"Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report","volume":"27","author":"Boriani S","year":"2018","unstructured":"Boriani S, Tedesco G, Ming L,  Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report. Eur Spine J. 2018;27(4):874\u2013881."},{"key":"b19","series-title":"World Neurosurg","first-page":"13","article-title":"The use of carbon fiber-reinforced instrumentation in patients with spinal oncologic tumors: a systematic review of literature and future directions","volume":"173","author":"Perez-Roman RJ","year":"2023","unstructured":"Perez-Roman RJ, Boddu JV, Bashti M,  The use of carbon fiber-reinforced instrumentation in patients with spinal oncologic tumors: a systematic review of literature and future directions. World Neurosurg. 2023;173:13\u201322."},{"issue":"3","key":"b20","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. Spine (Phila Pa 1976). 2022;47(3):252\u2013260."},{"issue":"1","key":"b21","series-title":"titanium. J Neurooncol","first-page":"155","article-title":"Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs","volume":"171","author":"Ward J","year":"2025","unstructured":"Ward J, Damante M, Wilson S,  Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs. titanium. J Neurooncol. 2025;171(1):155\u2013162."},{"issue":"2","key":"b22","series-title":"J Biomed Mater Res","first-page":"133","article-title":"Biological response to chopped-carbon-fiber-reinforced peek","volume":"26","author":"Jockisch KA","year":"1992","unstructured":"Jockisch KA, Brown SA, Bauer TW, Merritt K. Biological response to chopped-carbon-fiber-reinforced peek. J Biomed Mater Res. 1992;26(2):133\u2013146."},{"issue":"8","key":"b23","series-title":"Eur Spine J","first-page":"1775","article-title":"Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading","volume":"27","author":"Lindtner RA","year":"2018","unstructured":"Lindtner RA, Schmid R, Nydegger T, Konschake M, Schmoelz W. Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading. Eur Spine J. 2018;27(8):1775\u20131784."},{"issue":"8","key":"b24","series-title":"Bone Joint J","first-page":"1099","article-title":"Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison","volume":"98-B","author":"Weiser L","year":"2016","unstructured":"Weiser L, Dreimann M, Huber G,  Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison. Bone Joint J. 2016;98-B(8):1099-1105."},{"issue":"5","key":"b25","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience","volume":"50","author":"Newman WC","year":"2021","unstructured":"Newman WC, Amin AG, Villavieja J, Laufer I, Bilsky MH, Barzilai O. Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience. Neurosurg Focus. 2021;50(5):E11."},{"issue":"5","key":"b26","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability","volume":"50","author":"Massaad E","year":"2021","unstructured":"Massaad E, Rolle M, Hadzipasic M, Kiapour A, Shankar GM, Shin JH. Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability. Neurosurg Focus. 2021;50(5):E12."},{"issue":"3","key":"b1","series-title":"Oper Neurosurg (Hagerstown)","first-page":"310","article-title":"Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery","volume":"16","author":"Barzilai O","year":"2019","unstructured":"Barzilai O, Laufer I, Robin A, Xu R, Yamada Y, Bilsky MH. Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery. Oper Neurosurg (Hagerstown). 2019;16(3):310\u2013318."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"473","article-title":"Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases","volume":"38","author":"Chakravarthy VB","year":"2023","unstructured":"Chakravarthy VB, Hussain I, Laufer I,  Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases. J Neurosurg Spine. 2023;38(4):473\u2013480."},{"issue":"5","key":"b3","series-title":"Int Orthop","first-page":"309","article-title":"The incidence of vertebral body metastases","volume":"19","author":"Ortiz G\u00f3mez JA","year":"1995","unstructured":"Ortiz G\u00f3mez JA. The incidence of vertebral body metastases. Int Orthop. 1995;19(5):309\u2013311."},{"issue":"6","key":"b4","series-title":"Oncologist","first-page":"744","article-title":"The NOMS framework: approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Rubin DG, Lis E,  The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744\u2013751."},{"issue":"2","key":"b5","series-title":"Neurosurg Clin N Am","first-page":"151","article-title":"Neurologic, oncologic, mechanical, and systemic and other decision frameworks for spinal disease","volume":"31","author":"Newman WC","year":"2020","unstructured":"Newman WC, Laufer I, Bilsky MH. Neurologic, oncologic, mechanical, and systemic and other decision frameworks for spinal disease. Neurosurg Clin N Am. 2020;31(2):151\u2013166."},{"issue":"22","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"E1221","article-title":"A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher CG","year":"2010","unstructured":"Fisher CG, DiPaola CP, Ryken TC,  A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221\u2013E1229."},{"issue":"3","key":"b7","series-title":"J Spine Surg","first-page":"323","article-title":"Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors","volume":"3","author":"Tedesco G","year":"2017","unstructured":"Tedesco G, Gasbarrini A, Bandiera S, Ghermandi R, Boriani S. Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors. J Spine Surg. 2017;3(3):323\u2013329."},{"key":"b8","series-title":"World Neurosurg","first-page":"61","article-title":"Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations","volume":"152","author":"Takayanagi A","year":"2021","unstructured":"Takayanagi A, Siddiqi I, Ghanchi H,  Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors-clinical, radiographic, and dosimetric considerations. World Neurosurg. 2021;152:61\u201370."},{"issue":"8","key":"b9","series-title":"J Appl Clin Med Phys","first-page":"6","article-title":"The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems","volume":"21","author":"M\u00fcller BS","year":"2020","unstructured":"M\u00fcller BS, Ryang YM, Oechsner M,  The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems. J Appl Clin Med Phys. 2020;21(8):6\u201314."},{"issue":"5","key":"b10","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur?","volume":"50","author":"Meleis A","year":"2021","unstructured":"Meleis A, Larkin MB, Bastos DCA,  Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur?. Neurosurg Focus. 2021;50(5):E9."},{"issue":"8","key":"b11","series-title":"Clin Spine Surg","first-page":"E1015","article-title":"Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach","volume":"30","author":"Kumar N","year":"2017","unstructured":"Kumar N, Malhotra R, Maharajan K,  Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg. 2017;30(8):E1015\u2013E1021."},{"key":"b12","series-title":"World J Surg Oncol","first-page":"68","article-title":"Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review","volume":"13","author":"Yang Z","year":"2015","unstructured":"Yang Z, Yang Y, Zhang Y,  Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review. World J Surg Oncol. 2015;13:68."},{"issue":"5","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"593","article-title":"Utility of cement augmentation via percutaneous fenestrated pedicle screws for stabilization of cancer-related spinal instability","volume":"16","author":"Barzilai O","year":"2019","unstructured":"Barzilai O, McLaughlin L, Lis E, Reiner AS, Bilsky MH, Laufer I. Utility of cement augmentation via percutaneous fenestrated pedicle screws for stabilization of cancer-related spinal instability. Oper Neurosurg (Hagerstown). 2019;16(5):593\u2013599."},{"issue":"7","key":"b14","series-title":"Spine J","first-page":"1609","article-title":"Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability","volume":"15","author":"Moussazadeh N","year":"2015","unstructured":"Moussazadeh N, Rubin DG, McLaughlin L, Lis E, Bilsky MH, Laufer I. Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability. Spine J. 2015;15(7):1609\u20131617."},{"issue":"1","key":"b15","series-title":"Neurospine","first-page":"84","article-title":"Hardware failure in spinal tumor surgery: a hallmark of longer survival?","volume":"19","author":"Zaborovskii N","year":"2022","unstructured":"Zaborovskii N, Schlauch A, Ptashnikov D,  Hardware failure in spinal tumor surgery: a hallmark of longer survival?. Neurospine. 2022;19(1):84\u201395."},{"key":"b16","series-title":"J Clin Neurosci","first-page":"166","article-title":"Hardware failure in patients with metastatic cancer to the spine","volume":"45","author":"Pedreira R","year":"2017","unstructured":"Pedreira R, Abu-Bonsrah N, Karim Ahmed A,  Hardware failure in patients with metastatic cancer to the spine. J Clin Neurosci. 2017;45:166\u2013171."},{"issue":"12","key":"b17","series-title":"Eur Spine J","first-page":"3229","article-title":"Composite PEEK\/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series","volume":"29","author":"Boriani S","year":"2020","unstructured":"Boriani S, Pipola V, Cecchinato R,  Composite PEEK\/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series. Eur Spine J. 2020;29(12):3229\u20133236."},{"issue":"4","key":"b18","series-title":"Eur Spine J","first-page":"874","article-title":"Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report","volume":"27","author":"Boriani S","year":"2018","unstructured":"Boriani S, Tedesco G, Ming L,  Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report. Eur Spine J. 2018;27(4):874\u2013881."},{"key":"b19","series-title":"World Neurosurg","first-page":"13","article-title":"The use of carbon fiber-reinforced instrumentation in patients with spinal oncologic tumors: a systematic review of literature and future directions","volume":"173","author":"Perez-Roman RJ","year":"2023","unstructured":"Perez-Roman RJ, Boddu JV, Bashti M,  The use of carbon fiber-reinforced instrumentation in patients with spinal oncologic tumors: a systematic review of literature and future directions. World Neurosurg. 2023;173:13\u201322."},{"issue":"3","key":"b20","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. Spine (Phila Pa 1976). 2022;47(3):252\u2013260."},{"issue":"1","key":"b21","series-title":"titanium. J Neurooncol","first-page":"155","article-title":"Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs","volume":"171","author":"Ward J","year":"2025","unstructured":"Ward J, Damante M, Wilson S,  Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs. titanium. J Neurooncol. 2025;171(1):155\u2013162."},{"issue":"2","key":"b22","series-title":"J Biomed Mater Res","first-page":"133","article-title":"Biological response to chopped-carbon-fiber-reinforced peek","volume":"26","author":"Jockisch KA","year":"1992","unstructured":"Jockisch KA, Brown SA, Bauer TW, Merritt K. Biological response to chopped-carbon-fiber-reinforced peek. J Biomed Mater Res. 1992;26(2):133\u2013146."},{"issue":"8","key":"b23","series-title":"Eur Spine J","first-page":"1775","article-title":"Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading","volume":"27","author":"Lindtner RA","year":"2018","unstructured":"Lindtner RA, Schmid R, Nydegger T, Konschake M, Schmoelz W. Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading. Eur Spine J. 2018;27(8):1775\u20131784."},{"issue":"8","key":"b24","series-title":"Bone Joint J","first-page":"1099","article-title":"Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison","volume":"98-B","author":"Weiser L","year":"2016","unstructured":"Weiser L, Dreimann M, Huber G,  Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison. Bone Joint J. 2016;98-B(8):1099-1105."},{"issue":"5","key":"b25","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience","volume":"50","author":"Newman WC","year":"2021","unstructured":"Newman WC, Amin AG, Villavieja J, Laufer I, Bilsky MH, Barzilai O. Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience. Neurosurg Focus. 2021;50(5):E11."},{"issue":"5","key":"b26","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability","volume":"50","author":"Massaad E","year":"2021","unstructured":"Massaad E, Rolle M, Hadzipasic M, Kiapour A, Shankar GM, Shin JH. Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability. 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