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Background <p>Carbon fiber–reinforced polyetheretherketone (CFRP) instrumentation is increasingly used to manage primary and metastatic spinal tumors due to its radiolucency and similar biomechanical properties to titanium implants, which facilitate radiotherapeutic planning and postoperative surveillance. However, whether these advantages translate into comparable or improved clinical outcomes relative to conventional instrumentation is unclear.</p> Methods <p>Following PRISMA guidelines, databases were searched through November 2025 for studies evaluating CFRP instrumentation in adults undergoing surgery for primary or metastatic spinal tumors. Randomized controlled trials, prospective, and retrospective studies reporting at least one clinical outcome were included. Random-effects models were applied, with relative risks (RR) used for dichotomous outcomes and mean differences (MD) for continuous outcomes.</p> Results <p>A total of 1,609 patients were included, comprising 1,421 treated with CFRP and 188 with titanium instrumentation. Single-arm pooled prevalence analyses included all eligible studies, whereas comparative analyses were restricted to the four studies directly comparing CFRP and titanium instrumentation. The pooled hardware failure rate for CFRP was 3.5% (95% CI 2.3–5.2%), infection rate 3.9% (95% CI 2.1–7.3%), reoperation rate 6.2% (95% CI 3.8–9.8%), and recurrence rate 10.0% (95% CI 6.3–15.6%). Comparative analyses demonstrated no significant differences between CFRP and titanium instrumentation for hardware failure (RR 1.17, 95% CI 0.35–3.97; p=0.796), infection (RR 0.70, 95% CI 0.17–2.97; p=0.632), reoperation (RR 2.88, 95% CI 0.68–12.21; p=0.150), or tumor recurrence (RR 0.50, 95% CI 0.21–1.18; p=0.113). Operative time, length of stay, and survival analyses varied significantly across studies and were inconsistently reported, precluding pooled analyses.</p> Conclusion <p>In patients undergoing surgery for primary and metastatic spinal tumors, CFRP instrumentation shows complication, reoperation, and recurrence rates comparable to titanium implants. However, whether these advantages translate into improved long-term survival outcomes remains unclear. The current literature is largely observational, with limited follow-up and heterogeneity in patient populations and adjuvant treatments. Further prospective, multicenter, and propensity-matched studies are needed to clarify the impact of CFRP instrumentation on long-term outcomes and to define its role in spinal oncologic surgery.</p>

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Safety and efficacy of carbon fiber–reinforced polyetheretherketone implants in primary and metastatic spinal tumors: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Leonardo Di Cosmo,
  • Ely Feffer Barak,
  • Jad El Choueiri,
  • Christopher Peter Imbrogno,
  • Lucca Tamara Alves Carretta,
  • Lorenzo De Rossi,
  • Carlotta Ranalli,
  • Jordan Donna Simione,
  • Rahim Abo Kasem,
  • Ismail Zaed

摘要

Background

Carbon fiber–reinforced polyetheretherketone (CFRP) instrumentation is increasingly used to manage primary and metastatic spinal tumors due to its radiolucency and similar biomechanical properties to titanium implants, which facilitate radiotherapeutic planning and postoperative surveillance. However, whether these advantages translate into comparable or improved clinical outcomes relative to conventional instrumentation is unclear.

Methods

Following PRISMA guidelines, databases were searched through November 2025 for studies evaluating CFRP instrumentation in adults undergoing surgery for primary or metastatic spinal tumors. Randomized controlled trials, prospective, and retrospective studies reporting at least one clinical outcome were included. Random-effects models were applied, with relative risks (RR) used for dichotomous outcomes and mean differences (MD) for continuous outcomes.

Results

A total of 1,609 patients were included, comprising 1,421 treated with CFRP and 188 with titanium instrumentation. Single-arm pooled prevalence analyses included all eligible studies, whereas comparative analyses were restricted to the four studies directly comparing CFRP and titanium instrumentation. The pooled hardware failure rate for CFRP was 3.5% (95% CI 2.3–5.2%), infection rate 3.9% (95% CI 2.1–7.3%), reoperation rate 6.2% (95% CI 3.8–9.8%), and recurrence rate 10.0% (95% CI 6.3–15.6%). Comparative analyses demonstrated no significant differences between CFRP and titanium instrumentation for hardware failure (RR 1.17, 95% CI 0.35–3.97; p=0.796), infection (RR 0.70, 95% CI 0.17–2.97; p=0.632), reoperation (RR 2.88, 95% CI 0.68–12.21; p=0.150), or tumor recurrence (RR 0.50, 95% CI 0.21–1.18; p=0.113). Operative time, length of stay, and survival analyses varied significantly across studies and were inconsistently reported, precluding pooled analyses.

Conclusion

In patients undergoing surgery for primary and metastatic spinal tumors, CFRP instrumentation shows complication, reoperation, and recurrence rates comparable to titanium implants. However, whether these advantages translate into improved long-term survival outcomes remains unclear. The current literature is largely observational, with limited follow-up and heterogeneity in patient populations and adjuvant treatments. Further prospective, multicenter, and propensity-matched studies are needed to clarify the impact of CFRP instrumentation on long-term outcomes and to define its role in spinal oncologic surgery.