White Paper 2

Patient-Centered Care: The Benefits of BlackArmor® Carbon/PEEK in Avoiding Invasive CT Myelograms

This white paper concisely highlights the importance of improved postoperative MR imaging for patients with spinal metastases.

The Need for Clarity:
Optimizing Postoperative Imaging
in Spinal Tumor Care 

In the management of spinal tumor care, postoperative imaging plays an important role for the evaluation of surgical outcome, tumor surveillance, and adjuvant radiation therapy. 

For patients stabilized with hardware, the presence of titanium implants poses difficulties for precise postoperative evaluation and radiotherapy planning due to the imaging artifacts, especially when employing magnetic resonance imaging (MRI).

“Saving the CT myelogram is a significant advantage to the patient’s safety and satisfaction.”
Ran Lador, MD
Orthopedic Surgeon

CT myelograms have been introduced to overcome the challenges posed by metal hardware.1Redmond, K.J., et al., Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey. J Neurosurg Spine, 2017. 26(3): p. 299-306. This diagnostic imaging procedure involves injecting a contrast agent into the subarachnoid space to aid in visualizing the spinal cord and surrounding structures. The invasive nature of the procedure, associated with discomfort, can expose patients to potential risks, including infection, allergic reactions, and cerebrospinal fluid leaks.  

The introduction of BlackArmor® Carbon/PEEK implants is accompanied by artifact-free MR imaging. These radiolucent spinal implants provide surgeons and radiation oncologists with clear, comprehensive images of the spinal cord and surrounding structures. This not only eliminates the need for invasive CT myelograms2Fleege, C., et al., Carbon fiber-reinforced pedicle screws reduce artifacts in magnetic resonance imaging of patients with lumbar spondylodesis. Sci Rep, 2020. 10(1): p. 16094., but also contributes to increased patient safety and streamlines the overall treatment process. 

Meeting Surgeon

A recent study, comparing postoperative imaging measurements between titanium and BlackArmor® Carbon/PEEK implants, demonstrated the avoidance of repeating suboptimal CT myelograms in the BlackArmor® group, owing to the artifact-free MR imaging achieved.3Almeida, R.A.A., et al., Quantification of MRI Artifacts in Carbon Fiber Reinforced Polyetheretherketone Thoracolumbar Pedicle Screw Constructs prior to Spinal Stereotactic Radiosurgery. Pract Radiat Oncol, 2023.

In addition, MR images acquired using BlackArmor® Carbon/PEEK demonstrate the ability to detect epidural spinal cord compression resulting from postoperative fluid collection, helping to differentiate it from residual disease. This distinction contributes valuable insights, empowering healthcare professionals to make informed treatment decisions tailored to individual patient needs.

CT Myelogram
Fluid collection obscuring the CT myelogram. A) Post-op CT myelogram showing epidural compression. B) and C) axial T2 and T1 MRI with BlackArmor® Carbon/PEEK implants confirmed a postoperative fluid collection.
Taken from Almeida et al., 2023.

NOTE: Not all icotec implants have been evaluated for safety in the MR environment.
Some have not been tested for heating or unwanted movement in the MR environment.
The safety of these implants in the MR environment is unknown. Performing an MR exam on
a person who has such a medical device may result in injury. Please consult the respective instructions for use regarding information on the safety and compatibility of the individual icotec implants in the MR environment.