Carbon fiber-reinforced polyetheretherketone implants versus titanium implants for spinal tumors: a systematic review and meta-analysis.

PURPOSE: In the surgical treatment of spinal tumors, titanium has conventionally been the implant material of choice. However, they cause significant imaging artifacts, affecting radiotherapy planning and tumor surveillance. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implants minimize imaging artifacts, improve radiotherapy dosing, and reduce radiation scattering. We conducted a systematic review and meta-analysis to evaluate the complications, outcomes, and impact on radiotherapy after surgical fixation with CFR-PEEK implants for spinal tumors, with comparison to titanium implants. METHODS: PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched to March 2025. Primary outcomes were hardware failure, deep surgical infection, and reoperation for hardware-related complications or deep surgical infection. Secondary outcomes were local recurrence, mortality, length of hospital stay, and artifact volume. RESULTS: 32 studies were included, of which five were included in the comparative meta-analysis. Compared to the titanium group, the CFR-PEEK group had similar rates of hardware failure (OR = 1.73 [0.40–7.60], p = 0.47) and deep surgical infection (OR = 1.62 [0.49–5.38], p = 0.43). Local recurrence (OR = 0.58 [0.29–1.18], p = 0.13) and mortality rates (OR = 0.52 [0.25–1.09], p = 0.08) were non-significantly lower in the CFR-PEEK group. Length of stay (MD = −3.15 [−9.65, −3.34], p = 0.34) was comparable. CFR-PEEK implants generated significantly lower volume of imaging artifacts compared to titanium implants (SMD = −1.36 [−1.83, −0.90], p < 0.001). CONCLUSION: Whilst demonstrating non-inferiority in the rates of implant-related complications compared to titanium implants, CFR-PEEK implants significantly reduce artifact generation and may lead to lower recurrence and mortality due to improved radiotherapy planning and delivery. Prospective and randomized trials will further establish the evidence for CFR-PEEK implants in spine tumor surgery. CLINICAL TRIAL NUMBER: Not applicable.