Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report

Stefano Boriani, Giuseppe Tedesco, Lu Ming, Riccardo Ghermandi, Maurizio Amichetti, Piero Fossati, Marco Krengli, Loredana Mavilla, Alessandro Gasbarrini

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Protocols including combination of surgery and radiotherapy are more and more frequent in the treatment of bone tumors of the spine. In metastatic disease, combination of surgery and radiotherapy is since long time accepted, as based on clinical evidence. In primary tumors, combination of surgery and radiotherapy can be considered in all the cases in which a satisfactory oncological margin cannot be achieved: high-grade malignancies, recurrent tumors, huge tumors expanding in an extracompartimental area, and when tumor-free margin requires unacceptable functional sacrifices. However, metal implants are an obstacle in the collaboration between surgeons and radiation oncologists. Carbon-fiber-reinforced polyethil–ether–ether–ketone (CFR-PEEK) composite implants could make easier and more effective the treatment as radiolucent and not interfering with ionizing radiation and accelerated particles. The purpose of this article is to report the preliminary results from a cohort of patients treated with CFR-PEEK and to evaluate the safety and the non-inferiority of the device respect the commonly used titanium implants. Materials and methods: This study concerns an ambispective cohort series of 34 tumor patients (14 metastases and 20 primaries, most of them recurrent) submitted to thoracic and lumbar spine fixation with a CFR-PEEK composite implants. Oncologic surgery was palliative decompression and fixation in 9 cases, tumor excision in 21, and enbloc resection in 4. Data collected for this preliminary report were all intraoperative remarks, incidence of complications, changes in neurological status, local control, and survival. All the cases were followed 6–36 months (mean 13 months). Results: Only one intraoperative screw breakage occurred out of 232 implanted screws. Pain control and neurological improvement were the early clinical results. Two sacral screws loosening were found at 9 and 12 months in multilevel constructs performed on multirecurrent tumors. Six local recurrences were early found thanks to the implant radiolucency. Radiation oncologists’ opinion was favourable as concerning better treatment planning on CT and lacking of scattering effect during the treatment. Conclusions: No artifacts on imaging studies mean early local recurrence detection. For radiation oncologists, no artifacts on imaging studies mean easier planning and no scattering effect means more effective and safe radiotherapy, particularly when particles are used. Moreover, it seems that the clinical use of CFR-PEEK composite implants may be safe and at least comparable with the commonly used titanium implants in terms of intraoperative complications, stability at weight bearing and at functional recovery. Larger patient series and longer follow-up are required to confirm these data.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalEuropean Spine Journal
DOIs
Publication statusAccepted/In press - Aug 16 2017

Fingerprint

Spine
Neoplasms
Radiotherapy
Therapeutics
Titanium
Artifacts
Recurrence
carbon fiber
polyetheretherketone
Intraoperative Complications
Weight-Bearing
Decompression
Ionizing Radiation
Palliative Care
Thorax
Metals
Neoplasm Metastasis
Safety
Bone and Bones
Pain

Keywords

  • Carbon-fiber-reinforced PEEK
  • Radiotherapy
  • Scattering effect
  • Spinal metastasis
  • Spine tumor

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors : a preliminary report. / Boriani, Stefano; Tedesco, Giuseppe; Ming, Lu; Ghermandi, Riccardo; Amichetti, Maurizio; Fossati, Piero; Krengli, Marco; Mavilla, Loredana; Gasbarrini, Alessandro.

In: European Spine Journal, 16.08.2017, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Background: Protocols including combination of surgery and radiotherapy are more and more frequent in the treatment of bone tumors of the spine. In metastatic disease, combination of surgery and radiotherapy is since long time accepted, as based on clinical evidence. In primary tumors, combination of surgery and radiotherapy can be considered in all the cases in which a satisfactory oncological margin cannot be achieved: high-grade malignancies, recurrent tumors, huge tumors expanding in an extracompartimental area, and when tumor-free margin requires unacceptable functional sacrifices. However, metal implants are an obstacle in the collaboration between surgeons and radiation oncologists. Carbon-fiber-reinforced polyethil–ether–ether–ketone (CFR-PEEK) composite implants could make easier and more effective the treatment as radiolucent and not interfering with ionizing radiation and accelerated particles. The purpose of this article is to report the preliminary results from a cohort of patients treated with CFR-PEEK and to evaluate the safety and the non-inferiority of the device respect the commonly used titanium implants. Materials and methods: This study concerns an ambispective cohort series of 34 tumor patients (14 metastases and 20 primaries, most of them recurrent) submitted to thoracic and lumbar spine fixation with a CFR-PEEK composite implants. Oncologic surgery was palliative decompression and fixation in 9 cases, tumor excision in 21, and enbloc resection in 4. Data collected for this preliminary report were all intraoperative remarks, incidence of complications, changes in neurological status, local control, and survival. All the cases were followed 6–36 months (mean 13 months). Results: Only one intraoperative screw breakage occurred out of 232 implanted screws. Pain control and neurological improvement were the early clinical results. Two sacral screws loosening were found at 9 and 12 months in multilevel constructs performed on multirecurrent tumors. Six local recurrences were early found thanks to the implant radiolucency. Radiation oncologists’ opinion was favourable as concerning better treatment planning on CT and lacking of scattering effect during the treatment. Conclusions: No artifacts on imaging studies mean early local recurrence detection. For radiation oncologists, no artifacts on imaging studies mean easier planning and no scattering effect means more effective and safe radiotherapy, particularly when particles are used. Moreover, it seems that the clinical use of CFR-PEEK composite implants may be safe and at least comparable with the commonly used titanium implants in terms of intraoperative complications, stability at weight bearing and at functional recovery. Larger patient series and longer follow-up are required to confirm these data.",
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AU - Boriani, Stefano

AU - Tedesco, Giuseppe

AU - Ming, Lu

AU - Ghermandi, Riccardo

AU - Amichetti, Maurizio

AU - Fossati, Piero

AU - Krengli, Marco

AU - Mavilla, Loredana

AU - Gasbarrini, Alessandro

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