Pediatric Spinal Fusion Using CFR-PEEK Instrumentation: A Case Series

Introduction: Pediatric spine surgery presents unique challenges due to the development and growth of the patient. These patients require a precise balance of rigidity and flexibility to facilitate growth and protect an otherwise delicate spine. Carbon fiber reinforced polyertheretherketone (CFR-PEEK) hardware has recently shown efficacy as an alternative material for spinal fusion hardware in adult patients. The utility of CFR-PEEK hardware in pediatric patients has yet to be described. Here we present a case series describing the use of CFR-PEEK in seven pediatric spinal fusion surgeries.

Methods: Seven consecutive patients treated with spinal fusion surgery utilizing CFR-PEEK hardware were retrospectively reviewed. Patient demographics, indications, surgical details, additional therapies, and complications were recorded for each case.

Results: The average patient age was 17.8 ± 3.1 years. Two of the seven patients underwent surgery for deformity while the other five were for tumor resection. Of the five tumor patients, three had metastatic lesions. The average levels fused was 6.1 ± 2.9 levels and length of stay was 7.7 ± 3.4 days. The average follow up was 407 ± 246 days. Two patients presented with preoperative lower limb paresis with both resolving after surgery. Follow up demonstrated that all patients had a significant improvement in function. Of two patients with follow up CT available, average Hounsfield units (HU) at bilateral transverse process-superior articular process junction and facet joint among fixated levels were 694 HU ± 91.7 and 552 HU ± 24.8 respectively. One case had recurrence at 8 months, this was confounded by refusal of post-operative chemotherapy. Another case demonstrated adjacent segment kyphosis but remains asymptomatic. Finally, one patient passed away from aggressive sarcoma recurrence and metastatic disease burden just after six months after surgery.

Conclusion : In this case series, CFR-PEEK implants were safe and effective in pediatric spinal fixation surgeries. CFR-PEEK also provides additional advantages in monitoring progression, and adjunctive SRS therapy due to the radiolucency of the material. CFR-PEEK materials have significant advantages and warrant further evaluation in long term studies.