2631 - Carbon Fiber-PEEK Allows for Earlier Detection of Tumor Recurrence Compared to Titanium Instrumentation: A Comparative Study

J. Ward¹, V. Coelho², S. Wilson¹, M. Damante³, D. Franceschelli¹, S. Cua², D. Kreatsoulas², D. Xu⁴, A. N. Elguindy⁵, J. D. Palmer⁵, and V. Chakravarthy⁴; ¹The Ohio State University College of Medicine, Columbus, OH, ²The Ohio State University Department of Neurosurgery, Columbus, OH, ³Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, ⁴Department of neurosurgery, The James Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH, ⁵Department of Radiation Oncology, The James Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH

Purpose/Objective(s): Carbon fiber reinforced polyetheretherketone (CFRP) spinal instrumentation is increasingly utilized in the treatment of spine oncology patients for more accurate radiation treatment contouring and local control monitoring compared to traditional titanium instrumentation. The current literature is largely limited to single institutional experiences and systematic reviews. We hypothesized that with the use of CFRP, better post-operative visualization would allow us to detect tumor recurrence sooner than with the traditional titanium instrumentation. We aim to directly compare surgical and oncologic outcomes between CFRP and titanium instrumentation. Materials/

Methods: This is a retrospective review of 148 spine oncology patients treated surgically with decompression and fusion cased matched by spinal instability neoplastic score region and primary pathology in a 2:1 ratio (99 CFRP:49 Titanium instrumentation). Analysis of patient and treatment characteristics, surgical and oncologic outcomes was performed. Comparison of local failure rate and site of recurrence were evaluated.
Results: All patients were treated by posterolateral approach for decompression and fusion with either CFRP or titanium implants. Most common primary malignancy was renal cell carcinoma. Preoperative performance status did not differ between groups. Surgical characteristics including median surgery length, median hospital stay, average number of levels constructed, and estimated blood loss were all significantly lower in the CFRP group (p<0.0005). Complication profiles between the two were not significantly different when looking at hardware failure, infections, or needing additional tumor debulking (p=.551, p=1, p=1). The cumulative incidence of local recurrence was not significantly different between the groups (21 vs 15, p=0.227). The average time to detect recurrent disease among those with recurrence was 127.2 days in the CFRP group compared to 357.1 days in the titanium cohort (p=0.008).
Conclusion: CFRP instrumentation is associated with non-inferior complication profiles, while a shift in surgical management has changed the operative characteristics for these groups. Post-operatively, more effective surveillance allows for early detection and the opportunity for early retreatment. Further prospective analysis of patients treated with CFRP instrumentation is critical to understanding its potential clinical benefit.