The use of polymethylmethacrylate in cervical spine surgery

Abstract Introduction The use of polymethylmethacrylate (PMMA) after anterior cervical discectomy (ACD) shows high rates of graft migration and pseudarthrosis when compared with various other fusion procedures. Due to this fact, it is currently not considered the preferred choice of treatment in many countries. This review discusses the use of PMMA in cervical spine surgery. Materials and methods A literature review was conducted, and the articles were assessed for level of bias using the criteria recommended by the Cochrane Back Review Group. Results During last 30 years, five prospective and seven retrospective studies have been published that investigate PMMA-assisted ACD. While the radiological analysis shows inferior radiological results, the clinical outcome is not affected adversely by the intervertebral insertion of PMMA when compared with other r eplacement substrates. Conclusion Since there is no evidence that fusion is mandatory for clinical success, and no study has showed an inferior clinical outcome of PMMAassisted ACD in comparison with other substrates, PMMA can be used successfully in cervical spine surgery. Furthermore, the level of bias of the published studies supports the need of a controlled randomized multicentre trial. Only if fusion is mandatory for clinical success in certain cases, alternative grafts should be preferred since PMMA produces inferior radiological outcomes compared to cages or bone grafts.