Cement-Augmented Carbon Fiber-Reinforced Pedicle Screw Instrumentation for Spinal Metastases: Safety and Efficacy

World Neurosurg. 2021 Oct:154:e536-e546. doi: 10.1016/j.wneu.2021.07.092. Epub 2021 Jul 30.


Objective: To investigate the complication rates and long-term implant failure rates in a monocentric study of a consecutive cohort of patients with thoracolumbar spinal metastases after posterior instrumentation with a fenestrated carbon fiber-reinforced poly-ether-ether-ketone (CFRP) pedicle screw system.

Methods: We retrospectively reviewed demographics, Karnofsky Performance Status Scale scores, complications, and implant failure rates.

Results: Between June 2016 and November 2019, 51 consecutive patients underwent cement-augmented CFRP pedicle screw instrumentation at our institution. Mean age was 68 years (standard deviation 10.5), the median preoperative Karnofsky Performance Status Scale of 80 increased to 90 postoperatively (P = 0.471). Most common primary entities were breast (25.5%), lung (15.7%), and prostate (13.7%) cancers. Of 428 placed screws, 293 (68.5%) were augmented with polymethylmethacrylate, a mean 6 per patient (standard deviation ±2). Screws were inserted via a minimally invasive system technique in 54.9% of cases. In total, 11.8% of patients had immediate postoperative sequelae related to the cement. Pulmonary cement embolisms were noted in 3 patients, 2 had paravertebral extravasation, and 1 had an embolism into a segmental artery. Of these 6, 2 patients with pulmonary embolisms reported related symptoms. Follow-up was available for 80.4%. After a mean 9.8 months, screw loosening was noted in 11.8% of cases on computed tomography, although it was asymptomatic in all but 1 patient. Screw pull-out did not occur. Neither cement-related (P = 0.353) nor general complication rates (P = 0.507) differed significantly between open and minimally invasive system techniques.

Conclusions: Percutaneous cement-augmented CFRP pedicle screw instrumentation facilitates artifact-reduced postoperative imaging, while maintaining a risk profile and implant failure rates comparable to conventional metallic instrumentation.

Keywords: Carbon; Dement augmentation; Instrumentation; PEEK; Spinal metastasis.

MeSH terms

  • Aged
  • Carbon Fiber
  • Female
  • Humans
  • Male
  • Neurosurgical Procedures / instrumentation
  • Pedicle Screws*
  • Retrospective Studies
  • Spinal Neoplasms / epidemiology
  • Spinal Neoplasms / surgery*
  • Spine / surgery*
  • Treatment Outcome


  • Carbon Fiber