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

PEEK VBRs and CFR-PEEK cages supplemented with Funding
CFR-PEEK screws and rods. Adler et al. reported range of
motion (ROM) of six fresh frozen human thoracolumbar None.
spine units (T11-L3) had the smallest reduction when Conflict of interest
using a combination of CFR-PEEK VBRs and CFR-PEEK
screws and rods compared to its titanium counterparts The authors declare they have no competing interests.
with an axial and rotational measurement of 3.95° (18% Author contributions
reduction in ROM), and 1.84° (62% reduction in ROM),
respectively. These studies demonstrated additional Conceptualization: Vikram B. Chakravarthy, Jacob Ward
17
uses of CFR-PEEK beyond standard pedicle screw-rod Writing – original draft: Jacob Ward, Seth Wilson
constructs. Writing – reviewing & editing: All authors
Overall, our review shows an overall low rate of Ethics approval and consent to participate
complications and hardware failure with CFR-PEEK, but
further work is needed to understand the contribution Not applicable.
of this new technology to survival rates, the overall cost Consent for publication
of care, and postoperative patient-reported outcome
measures. Long-term outcome data, specifically with Not applicable.
respect to fusion, are also lacking due to the unfortunate
high overall mortality rates in spine oncology patients. Availability of data
Further work in these areas will help identify the best use Data for this study can be obtained from the cited original
cases for this emerging technology. articles.
We acknowledge limitations to this systematic review,
including study selection, direct study comparison, and Further disclosure
lack of robust prospective data. Our literature search was Part of these findings have been presented at the 2023 CNS
limited to two main databases. Although most published conference as a poster.
literature can be identified through these databases, it
is still possible to miss relevant studies. Besides, direct References
comparisons of data collected from the screened studies 1. Tsuchie H, Miyakoshi N, Hongo M, et al. Impact of a
were challenging due to the variations in study parameters specialized outpatient clinic on bone metastasis and its
and data collection. In addition, more articles describing burden on spine surgeons. In Vivo. 2021;35(6):3575-3579.
the use of CFR-PEEK in spine oncology that were doi: 10.21873/invivo.12661
published after the original screening of the databases were
not included in this review. 2. Van den Brande R, Cornips EM, Peeters M, Ost P, Billiet C,
Van de Kelft E. Epidemiology of spinal metastases, metastatic
5. Conclusion epidural spinal cord compression and pathologic vertebral
compression fractures in patients with solid tumors:
Overall, CFR-PEEK implants have shown non-inferiority A systematic review. J Bone Oncol. 2022;35:100446.
in durability and superiority in image artifact and doi: 10.1016/j.jbo.2022.100446
postoperative radiation therapy planning. This material
improves multiple facets of the adjuvant radiotherapy 3. Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, et al.
approach from planning to dosage and fractionation. 10-year trends in the surgical management of patients
with spinal metastases: A scoping review. World Neurosurg.
Taken together, this review demonstrates CFR-PEEK as 2022;157:170-186.e3.
a safe alternative to titanium instrumentation for spinal
fusion. The materialistic profile of CFR-PEEK, along with doi: 10.1016/j.wneu.2021.10.086
a decreased number of subsequent procedures performed, 4. Laufer I, Rubin DG, Lis E, et al. The NOMS framework:
make it a favorable option for patients with spine tumors. Approach to the treatment of spinal metastatic tumors.
However, future work should focus on advancements in Oncologist. 2013;18(6):744-751.
other aspects of oncologic care that can be accomplished doi: 10.1634/theoncologist.2012-0293
by utilizing CFR-PEEK instrumentation.
5. Cofano F, Di Perna G, Monticelli M, et al. Carbon
Acknowledgments fiber reinforced vs titanium implants for fixation in
spinal metastases: A comparative clinical study about
None. safety and effectiveness of the new “carbon-strategy.” J

Volume 2 Issue 2 (2024) 10 doi: 10.36922/arnm.3130