Outcomes and Complications Associated With 191 Carbon Fiber Pedicle Screws in Spinal Oncology Patients

<sec><title>Background</title> Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is used in spinal tumor surgery owing to its reduced artifact on postoperative imaging. </sec><sec><title>Objective</title> To evaluate the outcomes and complications associated with the use of CFR-PEEK instrumentation. </sec><sec><title>Methods</title> This case series reviews 35 patients who underwent surgery using CFR-PEEK instrumentation between December 2020 and April 2025 at 2 academic institutions. Variables collected included demographics, cancer type, tumor location, tumor histology, surgical technique (open vs minimally invasive), and mortality at the latest follow-up. Categorical variables were described with frequencies, while continuous variables were described with means and SDs. </sec><sec><title>Results</title> Thirty-five patients underwent 36 CFR-PEEK instrumentation procedures, utilizing a total of 191 screws. Patients had a mean age of 60.97 years (range: 15–83 years), and 23 patients (65.7%) were men. Thirty-one patients (88.6%) had metastatic spine tumors, with most tumors affecting the thoracic spine (51.4%). The most common histologies were multiple myeloma (<italic>n</italic> = 5) and lung cancer (<italic>n</italic> = 5). Twenty-two (66.6%) patients had a pathological fracture, while 16 (45.71%) had spinal cord compression on initial presentation. The mean estimated blood loss was 547.1 mL (range: 70–2000 mL). There were 1 intraoperative and 6 postoperative complications. One surgical revision was necessary due to a symptomatic screw. Median follow-up time was 5 months. The mortality rate at the latest follow-up was 40% (<italic>n</italic> = 14). </sec><sec><title>Conclusion</title> Our experience with CFR-PEEK implants demonstrates outcomes comparable to titanium implants. While CFR-PEEK facilitates the detection of local recurrences more quickly, long-term, large-scale studies are necessary to assess its cost-effectiveness. </sec><sec><title>Clinical Relevance</title> This case series describes the use of carbon fiber instrumentation in patients with spinal tumors and encourages future studies to compare it with other instrumentation methods. </sec><sec><title>Level of Evidence</title> 4. </sec>