Carbon fiber-PEEK pedicle screw instrumentation in spinal oncology: a retrospective case series, systematic review of the literature, and cost-effectiveness analysis.

PURPOSE: CFR-PEEK is an alternative to Titanium-based instrumentation offering reduced artifact and comparable biomechanical properties. However, its clinical outcomes, complication profile, and cost-effectiveness remain underexplored. In this study, we aim to: (1) Evaluate clinical results of patients who underwent surgical decompression and stabilization using CFR-PEEK instrumentation for primary or metastatic spinal tumors; (2) Perform a systematic review summarizing the published literature on CFR-PEEK in spinal oncology, and (3) Present a model for cost-effectiveness analysis of ‘Hybrid’ CFR-PEEK versus titanium instrumentation strategies. METHODS: We conducted: 1) A retrospective review of patients who underwent surgery for primary/metastatic spinal tumors using ‘Hybrid’ CFR-PEEK/Titanium. We assessed demographics, perioperative characteristics, hardware complications, local recurrence, and mortality. 2) Systematic review of CFR-PEEK instrumentation in spinal oncology. 3) Decision modeling-based economic evaluation comparing cost ($) and effectiveness (QALYs) of ‘Hybrid’ versus Titanium-only constructs. ICERs were calculated using a $150,000/QALY WTP threshold. RESULTS: Twenty-four patients (52.2% male) underwent surgery with ‘Hybrid/CFR-PEEK’ instrumentation at a total of 81 levels (mean 6.75 ± 1.8 screws/case). Patients underwent postoperative radiation in 16/24 (66.7%), of whom 10/16 (62.5%) received SBRT. Eleven patients had 15 complications with 1 hardware failure, 2 infections, and 4 reoperations. Mean follow-up was 7.8 ± 6.1 months. Local recurrence or progression occurred in 5/24 (20.8%) and mortality in 10/24 (41.7%) patients. In the systematic review, 28 articles met criteria (1,682 patients, Titanium 153 versus Carbon Fiber 1,529). Approximately 5,305 instrumented levels were analyzed, including 7,961 CFR-PEEK screws. Follow-up duration was ~ 14.11 months, with a total 294 complications and mortality rate of 18.2%. In our economic analysis, the mean cost of screw instrumentation per patient was $10,248 in the ‘Titanium’ cohort and between $8,805 - $22,012 in the ‘Hybrid/CFR-PEEK’ cohort. ICER for ‘Hybrid’/CFR-PEEK’ was $124,587/QALY at a cost of $3,420 per CFR-PEEK screw (3x Titanium) and $162,207/QALY at $3,990 per CFR-PEEK screw (3.5x Titanium). Reductions in CFR-PEEK screw costs demonstrated further cost-effectiveness at increased CFR-PEEK screw proportions within the construct. Probabilistic Sensitivity Analysis (PSA) with Monte Carlo Simulation trials confirmed our findings. CONCLUSION: CFR-PEEK instrumentation is safe, feasible, and potentially cost-effective in spinal oncology. Hybrid constructs offer a practical solution to balance clinical utility with cost.