Page 12 - ARNM-2-2

Advances in Radiotherapy
& Nuclear Medicine CFR-PEEK: A systematic review

Table 1. Overview of study objectives, inclusion criteria, and tumors examined
Authors Title of journal Main objectives Primary versus Inclusion criteria
metastatic
tumor
Tedesco et al., 2017 13 Journal of Spine Determine efficacy of CFR-PEEK Primary Primary tumor in the thoracic or lumbar spine
Surgery over traditional titanium with skeletal related events.
October 2014 – December 2016
Boriani et al., 2017 15 European Spine Evaluate safety and efficacy of Both primary Tumors of the thoracic and lumbar spine with
Journal CFR-PEEK compared to titanium and metastatic skeletal-related events.
implants December 2013 – July 2016
Ringel et al., 2020 9 World Investigate the pros and cons of Metastatic Spinal metastases with instability, spinal cord
Neurosurgery using CFR-PEEK for compression, and an
radiation planning and follow-up oncologic component with a life expectancy
imaging of>3 years.
August 2015 – December 2015
Cofano et al., 2020 5 Journal of Verify safety and effectiveness of Metastatic Diagnosis of spinal metastasis requiring
Clinical CFR-PEEK devices compared to surgery for instability, severe pain, epidural
Neuroscience standard titanium implants compression, and/or neurological impairment,
with the exclusion of posterior cervical
stabilization.
November 2017 – November 2019
Neal et al., 2021 11 Neurosurgical Demonstrate the feasibility and Both primary Primary or spinal metastases that did not
Focus advantages of CFR-PEEK implants and metastatic require custom rod contouring or occipital
in pts with primary and secondary plates.
osseous spinal tumors December 2018 – October 2022
Wagner et al., 2021 12 World Investigate complication rate Metastatic Surgically managed spinal metastases patients
Neurosurgery and long-term implant failure with CFR-PEEK instrumentation.
for CFR-PEEK screw usage for June 2016 – November 2019
thoracolumbar spinal metastases
Joerger et al., 2022 10 Cancers Report on safety and efficacy of Both primary Single center hospital with either primary or
CFR-PEEK for spinal neoplasms in and metastatic spinal metastases.
a large cohort August 2015 – December 2021
Hubertus et al., 2022 14 Scientific Determine the best intraoperative Both primary Primary spinal tumor or spinal metastases
Reports imaging modality for and metastatic treated with CFR-PEEK.
CFR screws in spinal oncology January 2018 – March 2021
patients
Alverez-Brekenridge Neurospine Determine safety and efficacy of Both primary Primary neoplasm and spinal metastases
et al., 2023 16 CFR-PEEK screws in terms of and metastatic treated with CFR-PEEK and titanium
tumor recurrence, imaging quality, hardware.
and radiation treatment therapy September 2019 – August 2021
Abbreviation: CFR-PEEK: Carbon fiber-reinforced polyetheretherketone.
issues on the same patient were not discussed in the or postoperative screw fracturing, rod breakage, and cage
articles. dislocation, occurring in 3.2% (19/592) of patients (95%
CI, 2.42 – 3.98), with 15 of 19 hardware fractures occurring
3.2.3. Mechanical complications intraoperatively, compared to 4 of the 19 occurred
Mechanical complications refer to any type of postoperatively. 5,9,10,13-16
hardware failure including screw loosening and rod or
screw breakage occurring both intraoperatively and 3.2.4. Other complications
postoperatively. Seven studies discussed screw loosening Other complications reported in multiple studies
and revealed its occurrence in 3.48% (21/603) of patients include epidural hematoma, incidental durotomy,
(95% CI, 3.03–3.93). 5,10-13,15,16 Screw loosening was assessed pulmonary embolism, new neurologic deficit,
postoperatively through lucency measured on either pneumonia/pleural effusion, urinary tract infection,
X-ray or computed tomography (CT). Seven studies also screw contact with the aortic wall, and cement-related
discussed hardware fractures, which include intraoperative complications. Of the listed complications, the most

Volume 2 Issue 2 (2024) 4 doi: 10.36922/arnm.3130