Evidence map›Paper›PMID 41615533›Full record

SynthesisJournal of neuro-oncology2026

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

A Daniel Davidar, Jawad M Khalifeh, Abdel-Hameed Al-Mistarehi, Ritvik Jillala, Yuanxuan Xia, Tej D Azad, A Karim Ahmed, Liam P Hughes, Joseph Rajasekaran, Abdul Karim Ghaith and 7 more

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

A Daniel Davidar *Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA. dlubelski@jhmi.edu.
Jawad M Khalifeh *Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Abdel-Hameed Al-MistarehiDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Ritvik JillalaDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Yuanxuan XiaDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Tej D AzadDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
A Karim AhmedDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Liam P HughesDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Joseph RajasekaranDrexel University College of Medicine, Philadelphia, PA, USA.
Abdul Karim GhaithDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Kristin J RedmondDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Majid KhanDepartment of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Timothy WithamDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Allan J BelzbergDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Ali BydonDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Nicholas TheodoreDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.
Daniel LubelskiDepartment of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street / Meyer 5-181, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCFR-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.

methodsWe 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.

resultsTwenty-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.

conclusionCFR-PEEK instrumentation is safe, feasible, and potentially cost-effective in spinal oncology. Hybrid constructs offer a practical solution to balance clinical utility with cost.

Indexed as

Carbon FiberDecompression, SurgicalKetonesPedicle ScrewsPolyethylene GlycolsSpinal NeoplasmsAgedBenzophenonesCost-Benefit AnalysisCost-Effectiveness AnalysisFemaleHumansMaleMiddle AgedPolymersRetrospective StudiesBenzophenonesCarbon FiberKetonespolyetheretherketonePolyethylene GlycolsPolymersCarbon fiber reinforced PEEKCost-effectivenessICERQALYSpinal oncologyStereotactic body radiotherapyTitanium

Identifiers

PMID41615533

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.