Use of carbon fiber-reinforced PEEK cages in spinal oncology patients: An institutional experience with emphasis on surgical, complication and imaging characteristics.

Abstract

Radiolucent carbon fiber-reinforced PEEK (CFRP) pedicle screws have improved imaging and radiation planning in spine oncology. However, these benefits are often limited by titanium cages used in combination. This study reports our initial experience using novel CFRP cages in oncologic spine surgeries, comparing their surgical feasibility, complications, and imaging performance to titanium cages. We retrospectively analyzed 13 patients who received CFRP cages between July 2021 and May 2023. Clinical, surgical, follow-up, and imaging data were evaluated. A matched cohort with titanium cages was used to assess postoperative MRI visibility of anatomical landmarks, rated by independent reviewers. Thirteen CFRP cages were implanted (mean age 61 ± 11 years; 54% female). Indications included spinal metastases (54%) and primary bone tumors. Most procedures involved the thoracic spine (62%), followed by lumbar (23%) and cervical (15%). Median instrumentation spanned 4 segments; 62% had two-staged surgeries. Three complications occurred: 1 cage dislocation (requiring revision), 1 wound infection, and 1 post-incisional hernia. Median radiologic follow-up was 74 days, with no further dislocations. Postoperative MRI showed significantly better visibility of key spinal landmarks with CFRP cages versus titanium (p < .05, Wilcoxon signed-rank test). CFRP cages are a viable alternative to titanium in oncologic spine surgery, offering comparable usability and improved postoperative imaging. These advantages may support better radiotherapy planning and complication detection, warranting further investigation.