P121. Carbon fiber reinforced PEEK implants for spine tumors: a single center experience

Abstract

<h3>BACKGROUND CONTEXT</h3> Titanium is the most common material used to manufacture spinal implants; however, its metallic properties are associated with imaging artifacts on CT and MRI scans which impede treatment planning and clinical follow among oncologic patients. Carbon fiber-reinforced Polyether ether ketone (CFR-PEEK) based spinal implants are an alternative to titanium, offering less image artifact as its titanium counterparts while maintaining similar biomechanical and biocompatibility properties. Its use in the management of spinal tumors has been reported, however the perceived advantages related to improved imaging quality, radiation treatment planning, and detection of tumor recurrence have not been fully assessed. <h3>PURPOSE</h3> We report our experience at the MD Anderson Cancer Center with the use of CFR-PEEK implants in the treatment of oncological patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective single-arm single-center study. <h3>PATIENT SAMPLE</h3> All consecutive patients from September 2019 to July 2021 who were operated for spine conditions and had carbon fiber-reinforced implants. <h3>METHODS</h3> We performed a retrospective review of the medical records and imaging studies of patients treated with CFR-PEEK implants from September 2019 to July 2021. Histology type, tumor location, construct features, time of follow up, type of adjuvant radiation, recurrences, overall survival and hardware related complications were recorded. <h3>RESULTS</h3> Seventy-one consecutive patients were assessed (20 primary tumors, 47 metastases, 4 others). The median time for followup was 5.4 months (Q1 1.13, Q3 11.9, IQR 10.77). Of those 6 patients received conventional external beam radiotherapy, 31 received spinal stereotactic radiosurgery with a median time to radiation of 35 days among primary tumors and 30 days among metastatic cases. A total of 4 patients with primary tumors presented recurrence at a median time of 4.7 months (N=4, Q1 2.7, Q3 7, IQR 4.3) and 7 patients with metastatic disease presented recurrence at a median time of 3.4 months (N=6, Q1 2.0, Q3 5.1, IQR 3.1). Hardware complications were observed in a total of 5 cases (7.04%) and included screw loosening, intraoperative screw breakage and loosened set screw. Imaging review demonstrated significant reduction in imaging artifact and enhanced detection of local recurrence when compared to similar cases operated with standard titanium spinal instrumentation. <h3>CONCLUSIONS</h3> Carbon fiber reinforced PEEK implants provided safe and effective spinal stabilization for patients with both primary and metastatic tumors while integrating into postoperative imaging and radiation planning. The associated reduction in imaging artifacts enhanced postoperative radiation planning and the ability to detect local recurrence. <h3>FDA DEVICE/DRUG STATUS</h3> Carbon fiber thoracolumbar screws and rods (Icotec AG, Altstätten, Switzerland) (Approved for this indication)