Narrative Review.The management of spinal tumors requires a multi-disciplinary approach
including surgery, radiation, and systemic therapy. Surgical approaches typically
require posterior segmental instrumentation to maintain long-term spinal stability.
Carbon fiber reinforced pedicle screws (CFRP) are increasingly used in the oncologic
setting due to reductions in both imaging artifacts and radiotherapy perturbations
compared to titanium implants. We performed a review of the literature and highlight
advantages and future areas of study for CFRP.We performed a systematic review of
the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines and identified 10 articles including 573 patients. Across all studies we
reviewed patient demographics, tumor types treated, hardware-related features, complication
rates, recurrence, survival, and follow-up.Across 10 studies, a total of 1371 screws
placed. Surgical and non-surgical complications were reported in 18.3% of patients.
Disease progression at the surgical site was detected in 7.3% of patients. There was
no significant difference in clinical or hardware complications between CFRP or titanium
implants. The most frequent complication attributable to implanted CFRP hardware included
screw breakage in 2.4% and loosening in 1.7% of patients, respectively.CFRP provide
a unique tool in the setting of spinal oncology. With a safety profile comparable
to titanium, we review the documented advantages of CFRP posterior implants compared
to titanium, while also addressing their current limitations. Additionally, we highlight
several areas of future research to identify the optimal patients who will achieve
the greatest benefit of CFRP.
