European Spine Journal

Composite PEEK/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series

Radiotherapy (RT) is frequently applied as an adjuvant therapy during spinal tumors treatment. Metallic implants can interfere with RT planning and execution, as it is known that metallic implants produce a backscattering effect that can limit RT accuracy and their presence can be associated with unwanted dose increase. PEEK/carbon fiber implants are designed to reduce these problems but their application in the cervical spine is limited, due to the reduced number and types of implants, the screw dimensions and the absence of lateral mass screws. We propose a hybrid system made of carbon rods and screws coupled with subliminal polyester bands with titanium clamps. We designed this hybrid construct to enclose the cervical region in the area of instrumentation without limiting the application of postoperative radiotherapy. Six patients in which the hybrid hardware was implanted were retrospectively examined. Data on demographics, intraoperative and postoperative events, tumor details and staging and cervical alignment were collected pre- and postoperatively. No intraoperative complications occurred. En bloc resection was performed in two patients, while the remaining four received an intralesional resection. Three out of six patients received postoperative RT, without any alteration in its planning and administration. Hybrid implants made of composite PEEK/carbon fiber screws and rods and sublaminar bands are a helpful solution for spinal reconstruction in the cervical and cervico-thoracic regions after spine tumor surgery. The implants do not produce artifacts at postoperative images, easing the planning and execution of postoperative radiotherapy.

Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer

The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.