Cadaveric biomechanical studies of PMMA-based bone augmentation: a scoping review of experimental setups and mechanical outcomes.

Background Polymethyl methacrylate (PMMA) has been extensively applied in augmentation procedures such as vertebroplasty and kyphoplasty. However, cadaveric biomechanical studies using PMMA remain heterogeneous in methodology and outcomes. This scoping review aimed to summarize experimental settings and mechanical findings of cadaver-based studies employing PMMA. Methods Following PRISMA-ScR guidelines, PubMed, Scopus, Web of Science, and IEEE Xplore were systematically searched. Eligible studies included human cadaveric biomechanical experiments in which PMMA was the primary augmentation material. Extracted data included bone type, preservation, tissue preparation, fixation, mechanical test configuration, and reported outcomes. Non-PMMA substitutes, animal studies, and purely computational models were excluded. Findings We identified 44 studies; 93.1% investigated vertebrae, and 84% used frozen preserved specimens. Vertebral studies predominantly assessed axial compression (48%), failure load (32%), and cyclic/fatigue testing (23%). Pre-processing (soft tissue/disc/marrow handling), potting, and cement condition varied widely. Testing configurations covered compression, bending, torsion, and height restoration under displacement or force control, with broad loading-rate ranges and at room temperature or 37 °C environments. Observed parameter ranges included displacement-controlled loading rates of 1–60 mm/min, force-controlled loading rates of 1–1600 N/s, preloads of 5–1600 N, and maximum loads of 5–8896 N. Primary outcomes were stiffness, failure load, and vertebral height restoration. Violin plots summarize distributional ranges and inter-study variability. Interpretation Cadaveric PMMA biomechanical studies remain largely vertebra-focused and protocol-dependent, with substantial variation in specimen preparation, cement handling, testing conditions, and outcome reporting. The observed parameter ranges should be interpreted as descriptive findings. To support clearer reporting and reproducible comparison, this review proposes core and study-specific reporting domains together with a reusable extracted dataset.