• Florian Ringel, Yu-Mi Ryang, Jan S Kirschke, Birgit S Müller, Jan J Wilkens, Jeremy Brodard, Stephanie E Combs, and Bernhard Meyer.
• Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neurosurgery, University of Mainz, Mainz, Germany. Electronic address: florian.ringel@unimedizin-mainz.de.
• World Neurosurg. 2017 Sep 1; 105: 294-301.

ObjectiveSurgical treatment of spinal tumors regularly includes spinal instrumentation with pedicle screws. Most modern pedicle screws are made of titanium alloy, which is associated with artifacts on postoperative imaging such as computed tomography and/or magnetic resonance imaging. These artifacts hamper radiation treatment planning and execution and follow-up imaging. Recently, carbon fiber-reinforced polyetheretherketone (CFRP) implants became available for posterior instrumentation with the aim to reduce imaging artifacts by implants.MethodsPatients harboring spinal tumors underwent posterior stabilization using CFRP pedicle screws. Postoperative imaging was evaluated for implant artifacts. Radiation planning was assessed.ResultsThirty-five patients with spinal tumors were assessed (metastases n = 30; lymphoma n = 2, myeloma n = 1, chordoma n = 1, fibrous dysplasia n = 1). Implantation of CFRP implants was feasible in all but 1 case. Postoperative images show reduced artifacts in comparison with standard titanium alloy implants. Implant position and integrity is sufficiently assessable despite reduced image contrast. Radiation planning is improved.ConclusionsCarbon fiber-reinforced PEEK pedicle screws reduce image artifacts on computed tomography and magnetic resonance imaging. Thereby, they are a valuable and feasible option for spinal instrumentations in patients harboring spinal tumors where postoperative imaging and radiation therapy planning are necessary and might be crucial for long-term outcome and overall survival.Copyright © 2017 Elsevier Inc. All rights reserved.

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