Radiolucent Carbon Fiber-Reinforced Pedicle Screws for Treatment of Spinal Tumors: Advantages for Radiation Planning and Follow-Up Imaging

Abstract

Objective: Surgical treatment of spinal tumors regularly includes spinal instrumentation with pedicle screws. Most modern pedicle screws are made of titanium alloy, which is associated with artifacts on postoperative imaging such as computed tomography and/or magnetic resonance imaging. These artifacts hamper radiation treatment planning and execution and follow-up imaging. Recently, carbon fiber-reinforced polyetheretherketone (CFRP) implants became available for posterior instrumentation with the aim to reduce imaging artifacts by implants.

Methods: Patients harboring spinal tumors underwent posterior stabilization using CFRP pedicle screws. Postoperative imaging was evaluated for implant artifacts. Radiation planning was assessed.

Results: Thirty-five patients with spinal tumors were assessed (metastases n = 30; lymphoma n = 2, myeloma n = 1, chordoma n = 1, fibrous dysplasia n = 1). Implantation of CFRP implants was feasible in all but 1 case. Postoperative images show reduced artifacts in comparison with standard titanium alloy implants. Implant position and integrity is sufficiently assessable despite reduced image contrast. Radiation planning is improved.

Conclusions: Carbon fiber-reinforced PEEK pedicle screws reduce image artifacts on computed tomography and magnetic resonance imaging. Thereby, they are a valuable and feasible option for spinal instrumentations in patients harboring spinal tumors where postoperative imaging and radiation therapy planning are necessary and might be crucial for long-term outcome and overall survival.

Keywords: Carbon fiber; Pedicle screws; Spinal chordoma; Spinal metastasis; Spinal radiation; Spinal stabilization; Spinal tumors.