P07.14.b Carbon Fiber-Reinforced Polyetheretherketone Implants Versus Titanium Implants for Spinal Tumors: A Systematic Review and Meta-Analysis

BACKGROUND Surgical treatment is a crucial component in the management strategy of spinal tumors. Conventionally, titanium has been the implant material of choice. However, these implants cause significant imaging artifacts, affecting radiotherapy planning and tumor surveillance. The use of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implants has been gaining traction in recent years. Due to their radiolucency and non-magnetizability, CFR-PEEK implants minimize interference on imaging, improve radiotherapy dosing, and reduce radiation scattering seen with metallic implants. We conducted a systematic review and meta-analysis to evaluate the implant-related complications, clinical outcomes, and impact on imaging and radiotherapy after surgical fixation with CFR-PEEK implants, and compare them to the use of titanium implants in patients with spinal tumors. MATERIAL AND METHODS PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched to March 2025. The review was conducted in accordance with the PRISMA guidelines. Primary outcomes were implant-related complications, including hardware failure, deep surgical infection, and reoperation for hardware-related complications or deep surgical infection. Secondary outcomes were local recurrence, mortality, length of hospital stay, and volume of imaging artifacts on postoperative CT. RESULTS 34 studies were included in the review, among which five studies had sufficient data for comparative meta-analysis. Compared to the titanium group, the CFR-PEEK group had similar rates of hardware failure (1.2% vs 0.7%, OR=1.73 [0.40-7.60], p=0.47) and deep surgical infection (2.1% vs 1.5%, OR=1.62 [0.49-5.38], p=0.43). Rates of local recurrence (8.8% vs 13.0%, OR=0.58 [0.29-1.18], p=0.13) and mortality (36.0% vs 50.3%, OR=0.52 [0.25-1.09], p=0.08) were non-significantly lower in the CFR-PEEK group. Length of stay (6.72 vs 10.45 days, MD=-3.15 [-9.65, -3.34], p=0.34) was comparable between the two groups. CFR-PEEK implants generated significantly lower volume of imaging artifacts compared to titanium implants (SMD=−1.36 [−1.83, −0.90], p<0.001). Meta-analysis of pooled proportions including non-comparative studies and both spinal metastases and primary spinal tumors were also reported. Given the paucity of in vivo data on the implications for radiotherapy, a supplementary review of in vitro studies comparing imaging artifacts and/or dosimetric data using CFR-PEEK versus titanium implants was included. CONCLUSION CFR-PEEK implants significantly reduce artifact generation and may potentially lead to lower recurrence and mortality rates due to improved radiotherapy planning and delivery. Complication rates were comparable to titanium implants. Prospective studies and randomized trials will further establish the evidence for CFR-PEEK implants in spine tumor surgery.