ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Safety and efficacy of carbon fiber-reinforced polyetheretherketone implants in primary and metastatic spinal tumors: a systematic review and meta-analysis.
Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 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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Abstract
backgroundCarbon fiber-reinforced polyetheretherketone (CFRP) instrumentation is increasingly used to manage primary and metastatic spinal tumors due to its radiolucency and similar biomechanical properties to titanium implants, which facilitate radiotherapeutic planning and postoperative surveillance. However, whether these advantages translate into comparable or improved clinical outcomes relative to conventional instrumentation is unclear.
methodsFollowing PRISMA guidelines, databases were searched through November 2025 for studies evaluating CFRP instrumentation in adults undergoing surgery for primary or metastatic spinal tumors. Randomized controlled trials, prospective, and retrospective studies reporting at least one clinical outcome were included. Random-effects models were applied, with relative risks (RR) used for dichotomous outcomes and mean differences (MD) for continuous outcomes.
resultsA total of 1,609 patients were included, comprising 1,421 treated with CFRP and 188 with titanium instrumentation. Single-arm pooled prevalence analyses included all eligible studies, whereas comparative analyses were restricted to the four studies directly comparing CFRP and titanium instrumentation. The pooled hardware failure rate for CFRP was 3.5% (95% CI 2.3-5.2%), infection rate 3.9% (95% CI 2.1-7.3%), reoperation rate 6.2% (95% CI 3.8-9.8%), and recurrence rate 10.0% (95% CI 6.3-15.6%). Comparative analyses demonstrated no significant differences between CFRP and titanium instrumentation for hardware failure (RR 1.17, 95% CI 0.35-3.97; p=0.796), infection (RR 0.70, 95% CI 0.17-2.97; p=0.632), reoperation (RR 2.88, 95% CI 0.68-12.21; p=0.150), or tumor recurrence (RR 0.50, 95% CI 0.21-1.18; p=0.113). Operative time, length of stay, and survival analyses varied significantly across studies and were inconsistently reported, precluding pooled analyses.
conclusionIn patients undergoing surgery for primary and metastatic spinal tumors, CFRP instrumentation shows complication, reoperation, and recurrence rates comparable to titanium implants. However, whether these advantages translate into improved long-term survival outcomes remains unclear. The current literature is largely observational, with limited follow-up and heterogeneity in patient populations and adjuvant treatments. Further prospective, multicenter, and propensity-matched studies are needed to clarify the impact of CFRP instrumentation on long-term outcomes and to define its role in spinal oncologic surgery.
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