Outcomes of 3D-printed titanium cages for surgical reconstruction in infectious spondylodiscitis: a systematic review

Infectious spondylodiscitis remains a complex spinal condition that may require surgical debridement and interbody reconstruction in cases of instability, deformity, or failure of medical management. Conventional reconstructive options include titanium mesh cages (TMC) and polyetheretherketone (PEEK) cages; however, three-dimensional printed titanium (3DPT) cages have been increasingly adopted due to their porous architecture and potential to enhance osseointegration. The clinical performance of 3DPT cages in the setting of spinal infection has not been well defined. This study aimed to qualitatively summarise the currently available direct and contextual evidence regarding the use of 3DPT cages for spinal reconstruction in infectious spondylodiscitis.

A systematic literature search of EMBASE, MEDLINE, and Cochrane Library was conducted up to December 2025. Studies reporting outcomes following spinal reconstruction using 3DPT cages in adult patients with infectious spondylodiscitis were included. Surgical parameters, radiological outcomes (including fusion and subsidence), and clinical outcomes were extracted and synthesised qualitatively due to heterogeneity in study design and outcome reporting.

A total of seven studies were included in this review. Among these, only one study directly evaluated 3DPT cages specifically in infectious spondylodiscitis, while the remaining studies provided indirect or contextual evidence from mixed-pathology or degenerative spinal cohorts. Overall, the available evidence remains highly limited and heterogeneous, with substantial variability in study design, outcome reporting, and follow-up duration.

Only limited direct evidence is currently available regarding the use of 3DPT cages in infectious spondylodiscitis. While early reports suggest that these implants may be feasible for spinal reconstruction, the current evidence base is highly limited, indirect, and heterogeneous, preventing definitive conclusions regarding clinical effectiveness or superiority over conventional interbody devices. Therefore, these findings should be interpreted as hypothesis-generating rather than practice-changing. Future well-designed prospective and comparative studies with standardised outcome measures are required to better define their role and enable meaningful meta-analysis.