Purpose: Carbon-fiber reinforced polyetheretherketone (CFRP)-based spinal implants are an alternative to titanium, offering less image artifact as their metallic counterparts while maintaining similar biomechanical and biocompatibility properties. Its use in the management of spinal tumors has been reported, however the perceived advantages related to improved imaging quality, radiation treatment planning, and detection of tumor recurrence have not been fully assessed.Methods: We performed a retrospective review of medical records amongst oncologic patients treated at MD Anderson Cancer Center with CFRP implants. Histology, tumor location, construct features, time of follow-up, adjuvant radiation, recurrences, overall survival, and hardware-related complications were recorded.Results: Sixty-nine consecutive patients were assessed (22 primary tumors, 47 metastases) and the median time for follow-up was 5.4 months. Amongst the cohort, a total of 491 CFRP pedicle screws were implanted. Hardware complications were observed in 5 cases (7.04%). Adjuvant radiation was completed in 8 patients with primary tumors and 29 patients with spinal metastases. A total of 28 patients (40.5%) from the combined primary and metastatic cohorts experienced systemic disease progression, with 12 patients (17.3%) demonstrating local recurrences. Amongst primary and metastatic tumors, overall survival (p = 0.363) and rate of local recurrence (p = 0.112) were similar.Conclusion: This largest series of CFRP implants demonstrates safe and effective spinal stabilization for patients with both primary and metastatic tumors. Enhanced postoperative imaging led to minimal imaging artifacts which facilitated postoperative radiation planning and the ability to detect local recurrence.

Objective: Intramedullary melanocytomas are extremely rare spinal cord tumors with distinct histopathological and imaging characteristics. This report reviews the literature on this pathology and presents a representative case study, highlighting aspects of diagnosis and management. Methods: A scoping review of PubMed, Web of Science, and Embase databases was conducted to identify reports on intramedullary melanocytomas, focusing on clinical presentation, imaging features, histopathology, treatment, and outcomes. Case reports and case series were included due to the rarity of these tumors. Results: Twelve manuscripts met the inclusion criteria, including 15 patients. In the majority of patients, intramedullary melanocytomas present with progressive myelopathy and pain. Most common MRI findings include hyperintensity on T1-weighted images, iso- to hypointensity on T2-weighted images, and homogeneous contrast enhancement. Intralesional cysts and associated syrinx are common. Gross total resection (GTR) remains the primary treatment, but complete removal is often challenging due to tumor adherence to neural structures. Conclusions: Intramedullary melanocytomas require careful diagnosis and management due to their diagnostic overlap with malignant melanoma and potential for recurrence. While GTR is the mainstay of treatment, long-term surveillance is warranted due to high recurrence rates. Further research is needed to define the natural history of the disease and establish optimal therapeutic strategies.

To comprehensively review the diagnostic features, clinical management, and surgical outcomes of spinal idiopathic hypertrophic pachymeningitis (sIHP) through a systematic analysis of existing literature. A systematic review was conducted using PubMed, EMBASE, Web of Science, and Cochrane databases from inception to October 31, 2024. Studies reporting on adult patients with sIHP, including clinical, treatment, outcome, and follow-up data, were included. Data extraction covered patient demographics, clinical presentation, diagnostic workup, management strategies, and outcomes. The review included 29 studies, comprising 8 case series and 21 case reports, with a total of 43 patients. The median age at diagnosis was 54 years, with a slight female predominance (53.5%). Common presenting symptoms included lower extremity weakness (51.2%), sensory complaints (48.8%), and back pain (46.5%). Magnetic resonance imaging was the primary diagnostic tool (86% of cases). Histopathological findings typically showed inflammatory infiltrate (74.4%) and fibrosis (59%). Steroid therapy was the primary medical management, with surgical decompression often necessary. The recurrence rate was 27.6%, with a median time to recurrence of 5 months. sIHP presents unique diagnostic and management challenges compared to its cranial counterpart. While sharing similarities in demographic patterns and diagnostic approaches, sIHP often requires more aggressive initial management due to the risk of irreversible neurological damage from spinal cord compression. The findings underscore the need to consider sIHP in the differential for patients with progressive myelopathic symptoms without signs of neoplasm.

Carbon fiber-reinforced polyetheretherketone (CFRP) spinal implants are gaining popularity in the surgical management of spinal metastasis because of their physical and radiographic properties, which facilitate adjuvant radiation planning and tumor surveillance. Their impact on clinical outcomes is still under investigation. We evaluated the role of hardware material (CFRP vs titanium) in local control and hardware durability in metastatic cases receiving decompressive surgery and adjuvant spinal stereotactic radiosurgery (SSRS). This single-institution, retrospective cohort study was approved by the local institutional review board. Patients who underwent decompressive surgery with posterior segmental instrumentation followed by treatment with SSRS for metastatic spine disease were included. Exclusion criteria were as follows: (1) cervical implants, (2) mixed-type hardware, (3) SSRS greater than 60 days after surgery, and (4) less than 3 months magnetic resonance imaging follow-up. Only tumor progression occurring inside or at the margins of the irradiated field was considered. Eighty-three spinal segments (55 titanium, 28 CFRP; from 82 patients) were evaluated. Except for the number of radiation fractions, proportion of single-fraction 24 Gy cases, and radiation equivalent dose in 2-Gy fractions, no significant differences were found between groups. The median follow-up time was 14.5 months (range, 3.0-70.4 months). Sixteen local progressions were identified, with 15 in the titanium group (P = .009). Using death as a competing factor, local progression-free survival was longer in the CFRP group (HR, 0.127; 95% CI, 0.017-0.945; P = .044). The median time to progression was 9.27 months (IQR, 4.5-15.65 months). Higher equivalent dose in 2-Gy fractions was the only variable associated with local tumor control in both univariate and multivariate analyses (P = .025 and P = .019, respectively). The titanium cohort experienced 4 hardware adverse events, whereas the CFRP group had 2 adverse events (P > .05). CFRP implants were associated with lower rates of local progression in crude analyses, but did not reach statistical significance in multivariable models. No differences in hardware durability were identified.