CMORE® Cervicothoracic System

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CMORE® Cervicothoracic System

Christian Mazel, Lorin Benneker, Michelle Clarke, Naresh Kumar, Firoz Miyanji, Yu-Mi Ryang, Maarten Spruit, Jean-Paul Wolinsky, Richard Bransford

Fig 1: The CMORE® CT System provides patients with cervicothoracic tumors access to radiolucent implants.

Approved by the AO Technical Commission in December 2025, the CMORE^® Cervicothoracic System (Fig 1) is a novel spine instrumentation system that is BlackArmor^® engineered Carbon/PEEK. Intended for use in patients with spinal tumors, de-novo spinal infections, and additional indications, the system offers a radiolucent alternative to conventional metallic implants. The clinical advantages of BlackArmor^® for patients and surgical teams include more precise targeting of radiation treatment, superior local tumor control, earlier detection of tumor recurrence and compatibility with advanced radiation modalities.

The product portfolio includes:

Screws in a different range of diameters and lengths
BlackArmor^® engineered Carbon/PEEK rods in various lengths and curvatures
Titanium straight rods
Axial and parallel connectors

Details
Disclaimer

The CMORE^® Screw features a BlackArmor^® tulip, a titanium nut screw, and tantalum markers, allowing the implant a degree of imaging visibility (Fig 2 and Fig 4). The screws are available in 4.0 mm, 4.5 mm and 5.0 mm diameters. The shank screw is available in a diameter of 4.0 mm.

The CMORE^® CT System is the first spinal implant that can also serve as a fiducial marker in radiotherapy [1]. It uses novel tantalum markers for IMR tracking with submillimeter accuracy, and provides greater confidence in the precision and safety of treatment while minimizing dose error to the target and spinal cord. This could potentially reduce both recurrence and toxicity to the patient.

Fig 2: Pedicle Screws from the CMORE® CT System. The comprehensive variety of screw diameters allows surgeons to tailor fixation to diverse patient anatomy, enhancing safety and construct stability in the challenging cervicothoracic region.

CMORE^® Rods and Connectors

The CMORE^® CT System offers a comprehensive selection of BlackArmor^® Carbon/PEEK rods (4.0 mm diameter, maximum length 200 mm), available in straight, curved, and S-configurations (Fig 3). Straight titanium rods supplement the system with a maximum length of 300 mm.

The connectors allow the secure joining of rods from the CMORE^® CT and VADER^® Pedicle Systems (Fig 3). Design features include titanium screws and a titanium ring that allows flexibility for rod insertion.

The CMORE^®Parallel- and Axial Connector can accommodate 4.0 mm Carbon/PEEK or 4.0 mm titanium rods and link them to 6.0 mm Carbon/PEEK or 6.0 mm titanium rods.

Fig 3: Rods and Connectors from the CMORE® CT System

Radiolucency and Clinical Benefits of BlackArmor^® Carbon/PEEK implants

The radiolucency of BlackArmor^® engineered Carbon/PEEK (Fig 4) offers numerous clinical benefits for spinal tumor patients:

More Precise Radiation Treatment

BlackArmor^® implants offer significant reduction in metal artifacts compared to titanium, improving postoperative imaging accuracy [2].
Increased accuracy in target and delineation of organs at risk (OAR), optimal radiation plan quality, and unimpeded dose delivery [2].

Improved Local Tumor Control

BlackArmor^® implants allow the delivery of a higher radiation dose without scattering (cold spots), reducing infield or marginal recurrence [3].

Earlier Recurrence Detection

In a matched cohort study (99 CFR-PEEK vs. 49 titanium cases), tumor recurrence was detected one scan earlier with Carbon/PEEK (mean94days vs.189days; p=0.013) [4].

Advanced Radiation Modalities

BlackArmor^® implants enable accurate proton and stereotactic photon planning with minimal dose uncertainty. The target coverage and OAR sparing is equivalent to that of non-instrumented spine [5].

Fig 4: Standard lateral X-ray showing the appearance of the CMORE® Cervicothoracic System. Only the metal components within the screw head and the tantalum markers are visible on X-ray, highlighting the radiolucency of the BlackArmor® components.

References

Lee-Poprocki H, Ritter AR, Upadhyay R, et al. Novel Intrafraction Motion Tracking During Postoperative Spine Stereotactic Irradiation for a Patient With Carbon Fiber Fixation Hardware. Practical Radiation Oncology. (2023) Nov-Dec;13 (6): 510-516.
de Almeida R, Ghia A, Amini B et al. Quantification of MRI Artifacts in Carbon Fiber Reinforced Polyetheretherketone Thoracolumbar Pedicle Screw Constructs prior to Spinal Stereotactic Radiosurgery. Practical Radiation Oncology. (2024); 14 (2): 103 –111.
de Almeida R, Call-Orellana F, Zuluaga-Garcia J et al. Local Control After Adjuvant Radiosurgery for Spinal Metastasis Treated With Decompression and Posterior Segmental Stabilization: A Comparison Between Carbon Fiber/Polyetheretherketone-Based and Metallic Implants. Advances in Radiation Oncology. (2025); 10 (7): 101806.
Ward J, Damante M, Wilson S et al. Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs. titanium. Journal of Neuro-Oncology. (2025); 171: 155–162.
Henzen D, Schmidhalter D, Guyer G et al. Feasibility of postoperative spine stereotactic body radiation therapy in proximity of carbon and titanium hybrid implants using a robotic radiotherapy device. Radiation Oncology. (2022); 17, 94.

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