Carbon-fiber-reinforced polyetheretherketone instrumentation in metastatic spine tumor surgery: technical considerations and potential pitfalls to avoid.

Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation has been reported in recent years for metastatic spine tumor surgery (MSTS). The benefits of CFR-PEEK include imaging artifact reduction, which enables more efficient follow-up and adjuvant radiotherapy (RT) planning compared with traditional titanium implants. Despite the increase in CFR-PEEK application in the literature, technical guides or considerations in terms of CFR-PEEK usage in MSTS are currently unavailable. This study aimed to highlight various important technical considerations and potential pitfalls for surgeons when applying CFR-PEEK instrumentation in MSTS. This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online, The Cochrane Library, and Scopus databases through December 31, 2024. This review included all studies related to CFR-PEEK instrumentation in MSTS. The vast personal experiences of the senior authors with the CFR-PEEK instrumentation circumstantiated the concepts emphasized in this paper. This review included 36 articles and discussed various considerations when planning for CFR-PEEK instrumentation in patients undergoing MSTS. Factors include preoperative construct planning, intraoperative CFR-PEEK system handling, and postoperative considerations such as the requirement for RT planning. This review is the first to highlight various considerations for MSTS surgeons when applying CFR-PEEK instrumentation. This serves as an important guide for surgeons performing MSTS, with the continuous evolution of our treatment capacity in metastatic spinal disease (Level of evidence: IV).