Outcomes and Complications Associated With 191 Carbon Fiber Pedicle Screws in Spinal Oncology Patients

Background Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is used in spinal tumor surgery owing to its reduced artifact on postoperative imaging. Objective To evaluate the outcomes and complications associated with the use of CFR-PEEK instrumentation. Methods This case series reviews 35 patients who underwent surgery using CFR-PEEK instrumentation between December 2020 and April 2025 at 2 academic institutions. Variables collected included demographics, cancer type, tumor location, tumor histology, surgical technique (open vs minimally invasive), and mortality at the latest follow-up. Categorical variables were described with frequencies, while continuous variables were described with means and SDs. Results Thirty-five patients underwent 36 CFR-PEEK instrumentation procedures, utilizing a total of 191 screws. Patients had a mean age of 60.97 years (range: 15–83 years), and 23 patients (65.7%) were men. Thirty-one patients (88.6%) had metastatic spine tumors, with most tumors affecting the thoracic spine (51.4%). The most common histologies were multiple myeloma (n = 5) and lung cancer (n = 5). Twenty-two (66.6%) patients had a pathological fracture, while 16 (45.71%) had spinal cord compression on initial presentation. The mean estimated blood loss was 547.1 mL (range: 70–2000 mL). There were 1 intraoperative and 6 postoperative complications. One surgical revision was necessary due to a symptomatic screw. Median follow-up time was 5 months. The mortality rate at the latest follow-up was 40% (n = 14). Conclusion Our experience with CFR-PEEK implants demonstrates outcomes comparable to titanium implants. While CFR-PEEK facilitates the detection of local recurrences more quickly, long-term, large-scale studies are necessary to assess its cost-effectiveness. Clinical Relevance This case series describes the use of carbon fiber instrumentation in patients with spinal tumors and encourages future studies to compare it with other instrumentation methods. Level of Evidence 4.