Carbon Fiber Pedicle Screws in Neuro-oncology: A Valuable Tool to Improve Radiographic Surveillance and Radiation Delivery

Introduction: The use of Carbon-Fiber Peek-Reinforced Pedicle Screws (CFS) is gaining favor due to potential benefits in spinal oncology patients. Literature supports CFS as equivalent to titanium screws in biomechanical, safety, and efficacy profiles. We present our experience with CFS as a valuable tool for improved imaging surveillance and accuracy in planning and delivering adjuvant radiotherapy.

Methods: All patients with metastatic or primary spinal disease who underwent CFS stabilization at the Moffitt Cancer Center from 2020-2022 were included in this study. Demographics, pathology, surgical characteristics, radiation therapy, and postoperative outcomes were collected. Cases were compared to equivalent, matched control cohorts for variables of interest and an illustrative case is presented showing differences in radiation field planning.

Results: Twenty-one patients ages 20-89 years underwent spinal instrumentation with CFS, with levels ranging from T4 to ilium. Average follow up was 6 months (range: 0.5-26 months). 5 patients died due to systemic disease progression. Patients presented with a wide range of tumor types, the majority being metastases (15/21). Open surgical technique was utilized in 86% of cases for tumor resection, while 14% of patients underwent resection with percutaneous stabilization. There were no instances of hardware malpositioning or revision perioperatively. All CFS were placed under fluoroscopic guidance. 10 (48%) patients underwent postoperative spinal stereotactic body radiation therapy with either IMRT or VMAT radiotherapy to the surgical bed. Radiotherapy was delivered in 5 (8/10) or 10 (2/10) fractions with the most common dosing being 400cGy (4/10) and 600cGy (2/10). On the most recent follow-up, none of the 21 patients showed evidence of local recurrence, hardware failure, or surgical site infection.

Conclusion : The use of CFS for spinal instrumentation in patients with spinal tumors has potential to improve clinical outcomes by allowing precise radiation dosing to target lesions and reduce imaging artifacts.