Durability of carbon fiber-reinforced PEEK spinal instrumentation in spine oncology: a single-institution longitudinal experience.

Objective: Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is increasingly being used in patients with spine tumors as the body of literature supporting its benefit in local disease surveillance and radiation planning grows. Small single-institution experiences with short-term follow-up have yet to demonstrate issues with construct durability despite different biomechanical properties of CFR-PEEK compared to titanium. In this study the authors evaluated CFR-PEEK hardware failures in patients with surgically treated spine tumors who had long-term follow-up.

Methods: This is an IRB-approved retrospective cohort study of patients with spine tumors who underwent instrumented spinal fusion with CFR-PEEK or titanium instrumentation at a single tertiary care center. Inclusion criteria were as follows: 1) age > 18 years; 2) pedicle screw fixation with CFR-PEEK or titanium; and 3) minimum 6 months of follow-up. The surgical indication was reviewed and agreed upon at a multidisciplinary spine tumor board meeting.

Results: A total of 190 patients undergoing CFR-PEEK instrumentation were identified during the study period; 148 had at least a 6-month follow-up. Of those 148, the median follow-up was 13.7 months. In total, there were 861 CFR-PEEK pedicle screws, 266 CFR-PEEK spinal rods, and 15 CFR-PEEK corpectomy cages included in the study. Percutaneous CFR-PEEK instrumentation was performed in 13 cases. There were 6 (4.1%) CFR-PEEK cases of mechanical/hardware failure, with a median interval time to failure of 5.51 (range 2.74-9.38) months. There were no hardware-related complications in the 26 patients who received CFR-PEEK instrumentation and who had a > 24-month follow-up.

Conclusions: This institutional experience provides the largest cohort with long-term follow-up to evaluate CFR-PEEK-related instrumentation failure in patients with spine tumors. The rate of hardware failure among CFR-PEEK instrumented constructs was comparable to that in the current literature for titanium implants used in degenerative spine and spine oncology treatment. Importantly, there were no hardware failures noted among patients with extended long-term survival, reinforcing the durability of CFR-PEEK instrumentation.