Carbon Fiber Versus Titanium Pedicle Screws : A Systematic Review of Radiologic, Biomechanical, and Clinical Features.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-07-15 Epub Date: 2025-04-08 DOI:10.1097/BRS.0000000000005356

Joshua M Coan, Alireza Gholipour, Abigail Tianai Zhang, Stefano Conti, Daphne Sorrentino, Daniel G Tobert

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引用次数: 0

Abstract

Study design: Systematic review.

Objective: This systematic review aims to compare the radiologic, biomechanical, and clinical features of CF versus Ti pedicle screws to clarify their respective advantages and limitations.

Background: Pedicle screw fixation is a cornerstone of spinal stabilization and titanium (Ti) implants are regarded as the standard. However, titanium screws are associated with imaging artifacts and dosimetric inaccuracies that complicate postoperative assessment and radiotherapy planning in spine oncology. Recently, carbon fiber (CF) pedicle screws emerged as a promising alternative, offering radiolucency and improved imaging characteristics.

Methods: Adhering to PRISMA guidelines, a comprehensive literature search was performed in PubMed, ScienceDirect, Web of Science, and EMBASE in September 2024 using the keywords "carbon fiber," "titanium," "screw," and "spine." Studies that directly compared CF and Ti pedicle screws across various spinal regions were included. Both in vitro and in vivo observational studies were considered. Data extraction focused on study design, methods, outcome measures, and limitations.

Results: Ten studies met the inclusion criteria. Biomechanical evaluation demonstrated CF screws offer comparable stability to Ti screws, with no differences in load cycles until failure or maximal axial force. Clinically, both screw types achieved significant improvements in axial pain and neurological function, although CF procedures were associated with increased operative times and blood loss. Radiologically, CF consistently produced fewer artifacts on CT and MRI, facilitating accurate imaging and radiation dose calculations, which are beneficial in oncological contexts.

Conclusion: CF pedicle screws represent a viable alternative to Ti implants, providing equivalent biomechanical performance and outcomes while offering superior radiologic clarity and dosimetric precision. These findings support the adoption of CF screws in spinal stabilization-particularly in cases requiring precise imaging and radiotherapy planning. This review provides a foundation to perform prospective comparative research on the technologies.

Level of evidence: Level III-systematic review of retrospective studies.

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碳纤维与钛椎弓根螺钉：放射学、生物力学和临床特征的系统综述。

研究设计：系统评价。目的：本系统综述旨在比较CF与Ti椎弓根螺钉的放射学、生物力学和临床特点，阐明其各自的优点和局限性。背景：椎弓根螺钉固定是脊柱稳定的基础，钛（Ti）植入物被视为标准。然而，在脊柱肿瘤学中，钛螺钉与成像伪影和剂量测定不准确相关，使术后评估和放疗计划复杂化。最近，碳纤维（CF）椎弓根螺钉作为一种很有前途的替代方案出现，它具有放射透光性和改善的成像特性。方法：根据PRISMA指南，于2024年9月在PubMed、ScienceDirect、Web of Science和EMBASE中检索关键词“碳纤维”、“钛”、“螺钉”和“脊柱”进行全面的文献检索。直接比较CF和Ti椎弓根螺钉跨不同脊柱区域的研究被纳入。考虑了体外和体内观察性研究。数据提取侧重于研究设计、方法、结果测量和局限性。结果：10项研究符合纳入标准。生物力学评估表明，CF螺钉与Ti螺钉具有相当的稳定性，在载荷循环中没有差异，直到失效或最大轴向力。临床上，两种螺钉类型均显著改善了轴痛和神经功能，尽管CF手术增加了手术时间和出血量。放射学上，CF在CT和MRI上产生的伪影较少，有助于准确成像和辐射剂量计算，这在肿瘤学背景下是有益的。结论：CF椎弓根螺钉是一种可行的替代钛植入物，具有相同的生物力学性能和效果，同时具有优越的放射清晰度和剂量学精度。这些发现支持CF螺钉用于脊柱稳定，特别是在需要精确成像和放疗计划的病例中。本文的综述为今后对这些技术进行前瞻性比较研究奠定了基础。证据水平：III，回顾性研究的系统评价。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.