{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:39:25Z","timestamp":1785425965984,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Research Agency, Poland","award":["2023\/ABM\/01\/00013"],"award-info":[{"award-number":["2023\/ABM\/01\/00013"]}]},{"award":["2023\/ABM\/01\/00013"],"award-info":[{"award-number":["2023\/ABM\/01\/00013"]}],"id":[{"id":"https:\/\/ror.org\/026nedj88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Patients undergoing surgery for metastatic spinal disease often require instrumented stabilization followed by radiotherapy and postoperative magnetic resonance imaging (MRI) surveillance. Titanium implants may generate artifacts that impair assessment of the operated level, whereas carbon fiber-reinforced polyetheretherketone (CFR-PEEK) constructs may improve MRI assessability. This study compared CFR-PEEK and titanium instrumentation with respect to postoperative MRI artifact burden, early outcomes, and oncological follow-up, and introduced a study-specific artifact grading system. Methods: This retrospective single-center cohort included 78 patients treated with instrumented stabilization for metastatic spinal disease: 33 with CFR-PEEK and 45 with titanium instrumentation. Postoperative MRI suitable for artifact assessment was available in 47 patients. Implant-related artifacts were evaluated using the Oncologic Spinal Instrumentation MRI Artifact Score (O-SIMAS), a 0\u20135 anatomy-based grading system. Early postoperative outcomes, local recurrence, progression-free survival, overall survival, and interrater agreement were analyzed. Results: CFR-PEEK instrumentation was associated with lower postoperative MRI artifact burden than titanium instrumentation, with median O-SIMAS scores of 2.0 versus 3.0, respectively (p &lt; 0.001). High-grade artifacts were less frequent after CFR-PEEK than after titanium instrumentation (15.8% versus 67.9%; p = 0.0008). Titanium instrumentation remained independently associated with high-grade artifacts. Early postoperative outcomes, local recurrence, progression-free survival, and overall survival did not differ significantly between groups. O-SIMAS showed substantial pairwise interrater agreement. Conclusions: CFR-PEEK instrumentation was associated with improved postoperative MRI assessability and fewer diagnostically relevant artifacts than titanium instrumentation. No oncological benefit was shown. O-SIMAS may support structured artifact assessment, but requires external validation.<\/jats:p>","DOI":"10.3390\/cancers18142199","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:40:09Z","timestamp":1783525209000},"page":"2199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative MRI Artifact Burden After Carbon Fiber-Reinforced PEEK Versus Titanium Instrumentation in Metastatic Spinal Disease"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6784-1969","authenticated-orcid":false,"given":"Kamil","family":"Krystkiewicz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Kowal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agata","family":"Krajniak","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6026-7177","authenticated-orcid":false,"given":"Micha\u0142","family":"Dziatosz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4962-3028","authenticated-orcid":false,"given":"Mateusz","family":"Bilski","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Affidea Nu-Med Center of Oncology Diagnostics and Therapy, 22-400 Zamosc, Poland"},{"name":"Department of Radiotherapy, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3568-269X","authenticated-orcid":false,"given":"\u0141ukasz","family":"Kuncman","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Medical University of Lodz, 93-513 Lodz, Poland"},{"name":"Department of External Beam Radiotherapy, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Tosik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Lodz, 93-513 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial","volume":"366","author":"Patchell","year":"2005","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","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","year":"2010","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J. 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