ArticleJournal of neurosurgery. Case lessons2026
Electrical stimulation properties of carbon fiber versus titanium pedicle screw instrumentation: illustrative case.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
backgroundCarbon fiber (CF) instrumentation is a useful tool for the treatment of spinal oncological disease. CF produces less instrumentation artifact on imaging, facilitating radiation planning and oncological monitoring. CF screws have different physical properties than traditional titanium, leading to decreased manual feedback during placement. Electromyography (EMG) monitoring is an intraoperative adjunct to assist in safe screw placement. While titanium and CF have different electrical properties, there is no literature comparing their responses to intraoperative stimulation. OBSERVATIONS: The authors present a case of mobile spine chordoma at L1 previously stabilized at an outside hospital. During en bloc resection, asymptomatic titanium screws at L2 were replaced with CF-reinforced PEEK (CFR-PEEK) (Icotec). Stimulation of the CFR-PEEK screws at 2 mA resulted in quadriceps EMG firing. Titanium screws at L3 required 10 mA of stimulation to produce an EMG signal (DePuy Synthes). Intraoperative CT demonstrated optimal screw placement. Postoperatively, the patient was neurologically intact. In ex vivo analysis, the CFR-PEEK screw exhibited increased resistivity and decreased conductivity compared to an analogous titanium screw. LESSONS: Surgeons and intraoperative monitoring teams should be aware of lower EMG stimulation thresholds for CF screws than titanium. Additional adjuncts, such as intraoperative imaging, may be helpful in these cases. https://thejns.org/doi/10.3171/CASE25786.
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