Utilization of Carbon Fiber Spinal Instrumentation in Primary Spinal Tumors: Outcome Analysis from the AO Spine Primary Tumor Research and Outcomes Network

Background The use of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation in spinal surgery has emerged as an alternative to traditional titanium-based implants in recent years. This study aims to evaluate the use and performance of carbon fiber instrumentation in patients with primary spinal tumors focusing on adverse event (AE) risk, overall survival and oncologic outcomes. Methods Data were collected from the AO Spine Primary Tumor Research and Outcomes Network (PTRON), a multicenter international registry. The primary endpoint was the incidence of AEs, while secondary endpoints included the risk of developing at least one AE, overall survival, local tumor control, and disease progression. Results A total of 359 patients enrolled in the PTRON registry met the inclusion criteria and were included in the study. Among them, 84 receiving carbon fiber implants (23%), 243 titanium implants (68%), and 32 a combination of both (9%). Median follow-up times were 1.9 years (IQR: 0.4-3.0), 1.3 years (IQR: 0.5-2.4) and 1.1 years (IQR: 0.5-1.7), in the carbon fiber, titanium and combination groups, respectively. The estimated risk of having at least one postoperative AE, including construct failures with and without loss of correction, wound infection (deep or superficial), non-union and wound dehiscence, was statistically comparable between patients receiving carbon fiber, titanium or a combination of both carbon fiber and titanium implants ( P > 0.05). Kaplan-Meier survival analyses and multivariable Cox proportional hazards models showed no significant differences in overall survival, recurrence-free survival, or progression-free survival between the implant groups. Conclusion Carbon fiber spinal implants demonstrate a comparable safety and oncologic profile to traditional titanium implants while allowing for improved tumor surveillance and easier radiation delivery.