Carbon Fiber Versus Titanium Pedicle Screws : A Systematic Review of Radiologic, Biomechanical, and Clinical Features.

STUDY

DESIGN

Systematic review.

OBJECTIVE

This systematic review aims to compare the radiologic, biomechanical, and clinical features of CF versus Ti pedicle screws to clarify their respective advantages and limitations.

BACKGROUND

Pedicle screw fixation is a cornerstone of spinal stabilization and titanium (Ti) implants are regarded as the standard. However, titanium screws are associated with imaging artifacts and dosimetric inaccuracies that complicate postoperative assessment and radiotherapy planning in spine oncology. Recently, carbon fiber (CF) pedicle screws emerged as a promising alternative, offering radiolucency and improved imaging characteristics.

METHODS

Adhering to PRISMA guidelines, a comprehensive literature search was performed in PubMed, ScienceDirect, Web of Science, and EMBASE in September 2024 using the keywords "carbon fiber," "titanium," "screw," and "spine." Studies that directly compared CF and Ti pedicle screws across various spinal regions were included. Both in vitro and in vivo observational studies were considered. Data extraction focused on study design, methods, outcome measures, and limitations.

RESULTS

Ten studies met the inclusion criteria. Biomechanical evaluation demonstrated CF screws offer comparable stability to Ti screws, with no differences in load cycles until failure or maximal axial force. Clinically, both screw types achieved significant improvements in axial pain and neurological function, although CF procedures were associated with increased operative times and blood loss. Radiologically, CF consistently produced fewer artifacts on CT and MRI, facilitating accurate imaging and radiation dose calculations, which are beneficial in oncological contexts.

CONCLUSION

CF pedicle screws represent a viable alternative to Ti implants, providing equivalent biomechanical performance and outcomes while offering superior radiologic clarity and dosimetric precision. These findings support the adoption of CF screws in spinal stabilization-particularly in cases requiring precise imaging and radiotherapy planning. This review provides a foundation to perform prospective comparative research on the technologies.

LEVEL OF EVIDENCE: Level III-systematic review of retrospective studies.