KEY POINTS
- This SANRA-guided narrative review searched PubMed and Scopus through April 2026 for evidence comparing titanium and carbon fiber-reinforced polyetheretherketone spinal implants in postoperative spine stereotactic body radiotherapy.
- Across computed tomography and magnetic resonance imaging studies, carbon fiber-reinforced polyetheretherketone implants consistently produced fewer artifacts than titanium. In one magnetic resonance imaging comparison, mean pedicle screw artifact size was 13.2 mm versus 5.8 mm, canal visualization was 15.5 mm versus 19.2 mm, and sagittal distortion was 1.9 mm versus 0.5 mm, all favoring carbon fiber-reinforced polyetheretherketone.
- Direct contouring evidence remains limited. One phantom study showed that titanium implants worsened contouring metrics versus no implant, with Hausdorff distance increasing from 2.2 mm to 18.2 mm and Dice coefficient decreasing from 0.88 to 0.57, but no study directly compared contouring accuracy between titanium and carbon fiber-reinforced polyetheretherketone.
- In photon therapy studies, carbon fiber-reinforced polyetheretherketone reduced dose perturbation and improved calculation accuracy. Reported maximum single-beam perturbation was more than 30% with titanium versus less than 5% with carbon fiber-reinforced polyetheretherketone; in volumetric modulated arc therapy, dose deviation within the planning target volume was 5–6% with titanium versus 2–3% with carbon fiber-reinforced polyetheretherketone.
- In proton therapy, titanium caused larger perturbations and reduced robustness. One phantom study reported clinical target volume underdose error of 17.3% with titanium versus 4.1% with carbon fiber-reinforced polyetheretherketone, while clinical outcome data remain heterogeneous and insufficient for definitive superiority claims.
CLINICAL TAKEAWAY
For patients likely to require postoperative spine stereotactic body radiotherapy, carbon fiber-reinforced polyetheretherketone implants appear technically advantageous because they reduce imaging artifacts, dose perturbation, and treatment-planning uncertainty compared with titanium. However, the review makes clear that clinical outcome evidence is still limited, especially for contouring accuracy, photon robustness, long-term local control, toxicity, and cost-effectiveness, so implant choice should remain multidisciplinary rather than automatic.