Minimally Invasive Robot-Assisted Placement of Long-Segment Carbon Fiber-Reinforced PEEK Instrumentation: Technical Note

Improved cancer survival has increased the incidence of spinal metastases, frequently resulting in pain, mechanical instability, and neurological deficits. Minimally invasive spine surgery reduces surgical morbidity and supports rapid recovery in oncologic patients. Emerging technologies, including carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation and robotic assistance, offer potential advantages by improving fixation accuracy and preserving postoperative imaging quality. A 63-year-old man with high-grade epithelioid hemangioendothelioma presented with severe refractory back pain due to an L4 pathologic fracture despite prior biopsy, ablation, kyphoplasty, and stereotactic body radiation therapy. Imaging demonstrated extensive lytic disease with mechanical instability (Spinal Instability Neoplastic Score 14) and low-grade epidural spinal cord compression (ESCC grade 1b). The patient was neurologically intact and underwent robot-assisted minimally invasive surgery (MIS) posterior spinal fusion from L2 to the ilium using CFR-PEEK pedicle screws and rods. The procedure was completed without complications. He was discharged home on postoperative day 4 with significant pain improvement and was able to promptly resume systemic therapy. This case demonstrates the novel application of robot-assisted MIS long-segment stabilization using CFR-PEEK instrumentation in an oncologic patient. This approach safely minimizes surgical morbidity while preserving imaging fidelity and facilitating timely continuation of cancer treatment.