Polyurethane grouting materials are polymer materials formed through the reaction of polyisocyanates and polyols. They play important roles in underground engineering, tunnel construction, and mining due to their fast reaction rate, high bonding strength, and excellent impermeability. However, traditional polyurethane grouting materials have shortcomings such as high reaction heat release, high brittleness, and poor flame retardancy, which limit their applications in high-demand engineering projects. This paper systematically reviews the research progress on modified polyurethane grouting materials. Four major modification technologies are summarized: temperature reduction modification, flame retardant modification, mechanical enhancement, and environmental adaptability improvement. A multi-dimensional performance characterization system is established, covering slurry properties, solidified body performance, microstructure characteristics, thermal properties and flame retardancy, diffusion grouting performance, and environmental adaptability. The application effects of modified polyurethane grouting materials in grouting reinforcement, grouting water plugging, and grouting lifting are analyzed. Future development directions are projected. This review is particularly valuable for researchers and engineers working in tunneling, mining, geotechnical engineering, and infrastructure rehabilitation.