• Arthur Wagner, Elena Haag, Ann-Kathrin Joerger, Jens Gempt, Sandro M Krieg, Maria Wostrack, and Bernhard Meyer.
• Department of Neurosurgery, Technical University Munich School of Medicine, Munich, Germany. Electronic address: arthur.wagner@tum.de.
• World Neurosurg. 2021 Oct 1; 154: e536-e546.

ObjectiveTo investigate the complication rates and long-term implant failure rates in a monocentric study of a consecutive cohort of patients with thoracolumbar spinal metastases after posterior instrumentation with a fenestrated carbon fiber-reinforced poly-ether-ether-ketone (CFRP) pedicle screw system.MethodsWe retrospectively reviewed demographics, Karnofsky Performance Status Scale scores, complications, and implant failure rates.ResultsBetween June 2016 and November 2019, 51 consecutive patients underwent cement-augmented CFRP pedicle screw instrumentation at our institution. Mean age was 68 years (standard deviation 10.5), the median preoperative Karnofsky Performance Status Scale of 80 increased to 90 postoperatively (P = 0.471). Most common primary entities were breast (25.5%), lung (15.7%), and prostate (13.7%) cancers. Of 428 placed screws, 293 (68.5%) were augmented with polymethylmethacrylate, a mean 6 per patient (standard deviation ±2). Screws were inserted via a minimally invasive system technique in 54.9% of cases. In total, 11.8% of patients had immediate postoperative sequelae related to the cement. Pulmonary cement embolisms were noted in 3 patients, 2 had paravertebral extravasation, and 1 had an embolism into a segmental artery. Of these 6, 2 patients with pulmonary embolisms reported related symptoms. Follow-up was available for 80.4%. After a mean 9.8 months, screw loosening was noted in 11.8% of cases on computed tomography, although it was asymptomatic in all but 1 patient. Screw pull-out did not occur. Neither cement-related (P = 0.353) nor general complication rates (P = 0.507) differed significantly between open and minimally invasive system techniques.ConclusionsPercutaneous cement-augmented CFRP pedicle screw instrumentation facilitates artifact-reduced postoperative imaging, while maintaining a risk profile and implant failure rates comparable to conventional metallic instrumentation.Copyright © 2021 Elsevier Inc. All rights reserved.

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