scholarly journals Carbon fiber–reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes

2021 ◽  
Vol 50 (5) ◽  
pp. E13
Author(s):  
Matthew T. Neal ◽  
Alexandra E. Richards ◽  
Kara L. Curley ◽  
Naresh P. Patel ◽  
Jonathan B. Ashman ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Titanium Implants ◽  
Particle Therapy ◽  
Spinal Tumors ◽  
Fiber Reinforced ◽  
Spinal Implants ◽  
Imaging Characteristics ◽  
The Mean ◽  
Carbon Fiber Reinforced

OBJECTIVE The authors aimed to demonstrate the feasibility and advantages of carbon fiber–reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. METHODS Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. RESULTS The study population included 14 females and 14 males with a mean age of 60 years (range 30–86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6–14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3–8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1–23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1–22 months). Eighteen patients received postoperative radiation at the authors’ institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CONCLUSIONS CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.

scholarly journals Carbon fiber–reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging

2020 ◽  
Author(s):  
Theresa Krätzig ◽  
Klaus C. Mende ◽  
Malte Mohme ◽  
Helge Kniep ◽  
Marc Dreimann ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Vertebral Body ◽  
Titanium Implants ◽  
Fiber Reinforced ◽  
Dose Delivery ◽  
Susceptibility Artifacts ◽  
Carbon Fiber Reinforced ◽  
Radiation Planning

Abstract Artifacts in computed tomography (CT) and magnetic resonance imaging (MRI) due to titanium implants in spine surgery are known to cause difficulties in follow-up imaging, radiation planning, and precise dose delivery in patients with spinal tumors. Carbon fiber–reinforced polyetheretherketon (CFRP) implants aim to reduce these artifacts. Our aim was to analyze susceptibility artifacts of these implants using a standardized in vitro model. Titanium and CFRP screw-rod phantoms were embedded in 3% agarose gel. Phantoms were scanned with Siemens Somatom AS Open and 3.0-T Siemens Skyra scanners. Regions of interest (ROIs) were plotted and analyzed for CT and MRI at clinically relevant localizations. CT voxel–based imaging analysis showed a significant difference of artifact intensity and central overlay between titanium and CFRP phantoms. For the virtual regions of the spinal canal, titanium implants (ti) presented − 30.7 HU vs. 33.4 HU mean for CFRP (p < 0.001), at the posterior margin of the vertebral body 68.9 HU (ti) vs. 59.8 HU (CFRP) (p < 0.001) and at the anterior part of the vertebral body 201.2 HU (ti) vs. 70.4 HU (CFRP) (p < 0.001), respectively. MRI data was only visually interpreted due to the low sample size and lack of an objective measuring system as Hounsfield units in CT. CT imaging of the phantom with typical implant configuration for thoracic stabilization could demonstrate a significant artifact reduction in CFRP implants compared with titanium implants for evaluation of index structures. Radiolucency with less artifacts provides a better interpretation of follow-up imaging, radiation planning, and more precise dose delivery.

Radiolucent Carbon Fiber–Reinforced Pedicle Screws for Treatment of Spinal Tumors: Advantages for Radiation Planning and Follow-Up Imaging

2017 ◽  
Vol 105 ◽  
pp. 294-301 ◽  
Author(s):  
Florian Ringel ◽  
Yu-Mi Ryang ◽  
Jan S. Kirschke ◽  
Birgit S. Müller ◽  
Jan J. Wilkens ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Pedicle Screws ◽  
Spinal Tumors ◽  
Fiber Reinforced ◽  
Carbon Fiber Reinforced ◽  
Radiation Planning

scholarly journals Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Florian A. Huber ◽  
Kai Sprengel ◽  
Lydia Müller ◽  
Laura C. Graf ◽  
Georg Osterhoff ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Image Reconstruction ◽  
Image Noise ◽  
Titanium Implants ◽  
Artifact Reduction ◽  
Metal Artifact ◽  
Metal Artifact Reduction ◽  
Fiber Reinforced ◽  
Carbon Fiber Reinforced ◽  
The Impact

Abstract Background CT artifacts induced by orthopedic implants can limit image quality and diagnostic yield. As a number of different strategies to reduce artifact extent exist, the aim of this study was to systematically compare ex vivo the impact of different CT metal artifact reduction (MAR) strategies on spine implants made of either standard titanium or carbon-fiber-reinforced-polyetheretherketone (CFR-PEEK). Methods Spine surgeons fluoroscopically-guided prepared six sheep spine cadavers with pedicle screws and rods of either titanium or CFR-PEEK. Samples were subjected to single- and dual-energy (DE) CT-imaging. Different tube voltages (80, DE mixed, 120 and tin-filtered 150 kVp) at comparable radiation dose and iterative reconstruction versus monoenergetic extrapolation (ME) techniques were compared. Also, the influence of image reconstruction kernels (soft vs. bone tissue) was investigated. Qualitative (Likert scores) and quantitative parameters (attenuation changes induced by implant artifact, implant diameter and image noise) were evaluated by two independent radiologists. Artifact degree of different MAR-strategies and implant materials were compared by multiple ANOVA analysis. Results CFR-PEEK implants induced markedly less artifacts than standard titanium implants (p < .001). This effect was substantially larger than any other tested MAR technique. Reconstruction algorithms had small impact in CFR-PEEK implants and differed significantly in MAR efficiency (p < .001) with best MAR performance for DECT ME 130 keV (bone kernel). Significant differences in image noise between reconstruction kernels were seen (p < .001) with minor impact on artifact degree. Conclusions CFR-PEEK spine implants induce significantly less artifacts than standard titanium compositions with higher MAR efficiency than any alternate scanning or image reconstruction strategy. DECT ME 130 keV image reconstructions showed least metal artifacts. Reconstruction kernels primarily modulate image noise with minor impact on artifact degree.

scholarly journals A Novel Spine Fixation System Made Entirely of Carbon-Fiber-Reinforced PEEK Composite: An In Vitro Mechanical Evaluation

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Ofir Uri ◽  
Yoram Folman ◽  
Gil Laufer ◽  
Eyal Behrbalk
Keyword(s):  
Mechanical Properties ◽  
Carbon Fiber ◽  
Torsional Stiffness ◽  
Fiber Reinforced ◽  
Peek Composite ◽  
The Mean ◽  
Carbon Fiber Reinforced ◽  
Spine Fixation ◽  
Fixation System

Background. Semirigid spine fixation systems utilizing nonmetallic materials have emerged as a promising innovation to overcome the inherent disadvantages of metal instrumentation in spine surgery. This study tests the mechanical properties of a novel spine fixation system made entirely of carbon-fiber-reinforced PEEK (CFR-PEEK) composite material (CarboClear System, CarboFix Orthopedics Ltd., Israel). Methods. An in vitro mechanical evaluation of the CFR-PEEK CarboClear system was conducted in compliance with the American Society for Testing and Materials (ASTM) F1717, F2193, and F543 standards. Results. The mean bending yield load, bending ultimate load, and bending stiffness of the construct were 322 N, 363 N, and 45 N/mm, respectively. All tested samples completed 5 × 106 dynamic cycles successfully, with no evidence of fatigue failure at increasing load levels, up to 83% of ultimate bending load. The mean torsional stiffness was 1.0 Nm/deg and the mean screw axial pull-out strength was 2,037 N. Conclusion. The CarboClear Pedicle Screw System has mechanical properties comparable to those of other commonly used titanium-made systems, with superior fatigue properties. The fatigue resistance, modulus of elasticity which is very similar to that of bone, radiolucency, and CT/MRI artifact-free feature of this spine fixation system made entirely of CFR-PEEK may offer advantages over traditional spine fixation systems made of metal alloys.

Disappointing long-term outcome of THA with carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) as acetabular insert liner: a prospective study with a mean follow-up of 14.3 years

2020 ◽  
pp. 112070002091815
Author(s):  
Luc JM Heijnens ◽  
Martijn GM Schotanus ◽  
Aart D Verburg ◽  
Emil H van Haaren
Keyword(s):  
Carbon Fiber ◽  
Acetabular Component ◽  
Fiber Reinforced ◽  
Ether Ether Ketone ◽  
Significant Difference ◽  
Poly Ether Ether Ketone ◽  
Ether Ketone ◽  
Carbon Fiber Reinforced ◽  
Acetabular Components

Introduction: Insert liner wear of the acetabular component is one of the predictive values for survival of total hip arthroplasties (THAs). This prospective single-centre study was designed to evaluate the follow-up of carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) insert liner used as bearing in cementless THAs. Methods: 29 healthy patients with an indication for cementless THA were selected for a CFR-PEEK insert liner and followed over time. All patients received a cementless THA with a CFR-PEEK insert liner used as bearing. At different follow-up moments patients were routinely examined and were analysed using the Oxford Hip Score (OHS), the modified Merle d’Aubigne-Postel (MAP) score, and radiologically. At the follow up moments the plain radiographics where assessed for loosening, cyst formations and wear of the CFR-PEEK liners. Results: At a mean of 14.3 years follow-up 4 revisions of the acetabular component were performed, resulting in a survival rate of 86.5% (CI 95%, 72.4–96.6). A statistically significant difference in OHS and MAP scores between pre- and postoperative follow-up moments was observed. The acetabular components of the remaining patients showed no radiological abnormalities at 14.3 years follow-up. The overall CFR-PEEK wear was low, with a mean of 0.81 (0.2–1.4) mm wear at 14.3 years follow-up. Conclusions: In this series we found an aseptic loosening with unclear reasons in 4 well-positioned acetabular components, hence we do not recommend routine use of CFR-PEEK insert liners as bearing in cementless THAs. All the remaining THAs and acetabular components were in situ without abnormalities at 14.3 years follow-up.

Radiolucent carbon fiber-reinforced implants for treatment of spinal tumors- clinical, radiographic, and dosimetric considerations

2021 ◽  
Author(s):  
Ariel Takayanagi ◽  
Imran Siddiqi ◽  
Hammad Ghanchi ◽  
Jonathan Lischalk ◽  
Frank Vrionis ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Spinal Tumors ◽  
Fiber Reinforced ◽  
Carbon Fiber Reinforced
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