Polymethyl Methacrylate (PMMA) Cement as an Interbody Spacer in Pyogenic Spondylodiscitis: Results of a Scoping Review.

Abstract

Study DesignScoping review.ObjectiveTo systematically map and characterize the literature on the use of polymethyl methacrylate (PMMA) cement as an interbody spacer in the surgical management of pyogenic spondylodiscitis.MethodsA comprehensive search of MEDLINE, EMBASE, Web of Science, and Cochrane Library databases was conducted from their inception through February 2026. Studies reporting PMMA cement used as an interbody for pyogenic spondylodiscitis were included. Postoperative surgical site infections were excluded. Data were synthesized descriptively following scoping review framework (PRISMA-ScR).ResultsEight studies involving 203 patients (2013-2024) were identified. Common surgical indications included neurological deficit, instability, epidural abscess, and failure of medical management. Antibiotic-impregnated PMMA was used in seven studies (most commonly vancomycin + tobramycin or gentamicin). No major PMMA-related complications were reported, although one study mentioned a case of PMMA implant dislocation, requiring revision surgery during the same admission. Infection recurrence was low (1.4-1.6%). Fusion rates ranged from 95.9% to 100% when assessed (n=150). Fusion was commonly observed despite permanent PMMA implantation. Patient-reported outcomes were infrequently assessed but reported improvements in pain scores.ConclusionsLimited level IV evidence suggests that antibiotic-impregnated PMMA interbody placement is associated with high rates of infection control and fusion in pyogenic spondylodiscitis, particularly when significant endplate destruction is present and anterior column support is needed. No major PMMA-related complications were reported in the available literature. Well-designed comparative studies are warranted to clarify optimal patient selection, long-term durability, and the relative advantages of PMMA, if any, over contemporary reconstructive techniques.