Evolution of materials for implants in metastatic spine disease till date – Have we found an ideal material?

Kumar, Naresh; Lopez, Keith Gerard; Ramakrishnan, Sridharan Alathur; Hallinan, James Thomas Patrick Decourcy; Fuh, Jerry Ying Hsi; Pandita, Naveen; Madhu, Sirisha; Kumar, Aravind; Benneker, Lorin Michael; Vellayappan, Balamurugan

doi:10.1016/j.radonc.2021.08.007

Cited by 14 publications

(11 citation statements)

References 110 publications

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“…In RT planning, target segmentation on planning CT might be impaired due to implants. Image artifacts might reduce the quality of the scan, potentially obscure target and risk structures, and lead to inaccuracies regarding image fusion [ 6 , 11 ]. Furthermore, CT artifacts surrounding metallic implants lead to inaccurate estimation of Hounsfield Units and electron density, resulting in dose calculation errors [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Image artifacts might reduce the quality of the scan, potentially obscure target and risk structures, and lead to inaccuracies regarding image fusion [ 6 , 11 ]. Furthermore, CT artifacts surrounding metallic implants lead to inaccurate estimation of Hounsfield Units and electron density, resulting in dose calculation errors [ 10 , 11 ]. Regarding RT delivery, the high electron density of metallic implants leads to dose perturbation [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, CT artifacts surrounding metallic implants lead to inaccurate estimation of Hounsfield Units and electron density, resulting in dose calculation errors [ 10 , 11 ]. Regarding RT delivery, the high electron density of metallic implants leads to dose perturbation [ 11 , 13 ]. This might result in compromised tumor control of structures located distal to the implant and lead to overdosing of potential adjacent risk structures such as the spinal cord [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding RT delivery, the high electron density of metallic implants leads to dose perturbation [ 11 , 13 ]. This might result in compromised tumor control of structures located distal to the implant and lead to overdosing of potential adjacent risk structures such as the spinal cord [ 11 , 13 ]. CFR PEEK–based implants show reduced artifacts on CT imaging and help to minimize effects of dose perturbation in RT delivery [ 11 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Clinical evaluation of vertebral body replacement of carbon fiber–reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine

et al. 2023

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Purpose Radiolucent anterior and posterior implants by carbon fiber–reinforced polyetheretherketone (CFR PEEK) aim to improve treatment of primary and secondary tumors of the spine during the last years. The aim of this study was to evaluate clinical and radiological outcomes after dorsoventral instrumentation using a CFR PEEK implant in a cohort of patients representing clinical reality. Methods A total of 25 patients with tumor manifestation of the thoracic and lumbar spine underwent vertebral body replacement (VBR) using an expandable CFR PEEK implant between January 2021 and January 2022. Patient outcome, complications, and radiographic follow-up were analyzed. Results A consecutive series aged 65.8 ± 14.7 (27.6–91.2) years were treated at 37 vertebrae of tumor manifestation, including two cases (8.0%) of primary tumor as well as 23 cases (92.0%) of spinal metastases. Overall, 26 cages covering a median of 1 level (1–4) were implanted. Duration of surgery was 134 ± 104 (65–576) min, with a blood loss of 792 ± 785 (100–4000) ml. No intraoperative cage revision was required. Surgical complications were reported in three (12.0%) cases including hemothorax in two cases (one intraoperative, one postoperative) and atrophic wound healing disorder in one case. In two cases (8.0%), revision surgery was performed (fracture of the adjacent tumorous vertebrae, progressive construct failure regarding cage subsidence). No implant failure was observed. Conclusion VBR using CFR PEEK cages represents a legitimate surgical strategy which opens a variety of improvements—especially in patients in need of postoperative radiotherapy of the spine and MRI-based follow-up examinations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical evaluation of vertebral body replacement of carbon fiber–reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine

et al. 2023

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“…The use of carbon fibre reinforced polymer (C-FRP) implants, for example, carbon fibres with reinforced polyetheretherketone (CFR-PEEK) have shown promise in this field (Figure 3a-f). In addition to being radiolucent and nonmagnetizable, these have favourable characteristics suitable for use as an orthopaedic implant including low weight, good mechanical strength and improved load transfer to bone, thereby reducing stress-shielding [37,[39][40][41]. In a 2015 qualitative assessment of metal artifacts in patients with femoral or tibial intramedullary nails, CFR-PEEK implants showed reduced metal-related artifacts on T1-weighted, STIR and contrast-enhanced fat-suppressed T1-weighted imaging compared to titanium implants, with high intraobserver agreement [42].…”

Section: Challenges Of Mri: Metal-related Artifactsmentioning

confidence: 99%

State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression

Kuah

Vellayappan

Makmur

et al. 2022

Cancers

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Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.

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Radiolucent implants in orthopedic oncology

Federico,

Trevino,

Zavras

et al. 2023

Journal of Surgical Oncology

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Radiolucent implants in have demonstrated promising results for both extremity and spine oncologic procedures. However, questions persist about whether the superiority in surveillance imaging justify the increased cost and technical challenges. In this review, we present the current body of literature for the use of radiolucent implants in musculoskeletal oncology, with a focus on implant complications, including screw loosening, breakage, malposition, and loss of reduction. We also discuss clinical outcomes, technical considerations, and postoperative radiotherapy.

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Evolution of materials for implants in metastatic spine disease till date – Have we found an ideal material?

Cited by 14 publications

References 110 publications

Clinical evaluation of vertebral body replacement of carbon fiber–reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine

Clinical evaluation of vertebral body replacement of carbon fiber–reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine

State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression

Radiolucent implants in orthopedic oncology

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