Separation surgery with cement-augmented short-segment fixation for spinal metastasis: early experience with carbon fiber-reinforced polyetheretherketone instrumentation.

Objective: The concept of hybrid therapy as separation surgery, followed by stereotactic radiation therapy or stereotactic body radiation therapy, is becoming the new standard of care in the management of metastatic epidural spinal cord compressions (MESCCs). Nevertheless, this new concept remains a form of palliative treatment, and surgical efforts to minimize morbidity and prolong survival serve to maximize palliation. Such strategies include short-segment fixation with cement augmentation, described as 1 level above and below the index level of the MESCC (single vertebral body level). The use of carbon fiber-reinforced polyetheretherketone (CFRP) instrumentation has allowed precise contouring in radiation planning and earlier detection of tumor recurrence, while being biomechanically comparable to standard titanium instrumentation. Therefore, the authors wanted to explore the feasibility of short-segment cement-augmented CFRP instrumentation for patients with spinal metastasis requiring separation surgery.

Methods: A retrospective review was conducted from April 2022 to May 2024. Inclusion criteria were as follows: 1) patients who had open separation surgery for MESCC, 2) with short-segment cement-augmented CFRP instrumentation (defined as 1 level above and below the index disease level), 3) who underwent postoperative radiation therapy, with 4) a minimum 6 months of survival.

Results: Twenty-eight patients met the inclusion criteria. The mean survival was 14.9 months, mean radiographic follow-up was 7.9 months, median estimated blood loss was 300 ml, and mean operative time was 214 minutes. There were no cement- or hardware-related complications. There were 3 cases of postoperative kyphosis, one of which was symptomatic, but all were managed nonoperatively. One patient required a reoperation for repair of a CSF leak.

Conclusions: Short-segment cement-augmented fixation is a feasible strategy in open separation surgery for MESCC. This is the first clinical study to incorporate the use of CFRP instrumentation in such a surgical strategy. Additional studies with larger sample sizes and longer durations of follow-up would support both the durability and potential survival benefit over titanium instrumentation.