Vertebroplasty / Kyphoplasty

Introduction

Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat painful fractures of the spinal bones, called vertebrae. These fractures — known as vertebral compression fractures — happen when one of the small blocks of bone that make up the spine collapses, often because the bone has been weakened by osteoporosis, cancer, or injury. The result can be sudden, sharp back pain, a loss of height, or a forward curve of the upper back.

If you are reading this, you or a family member has likely been told that a vertebral compression fracture is the cause of the pain, and that vertebroplasty or kyphoplasty has been suggested as a possible treatment. This article explains what each procedure is, how they differ, who is generally a candidate, what to expect on the day of the procedure, and what recovery typically looks like. It also covers risks, alternatives, and the longer-term care of the bone disease that often causes these fractures in the first place.

The two procedures together are sometimes called “vertebral augmentation,” because both involve strengthening a broken vertebra by injecting a special bone cement into it. They are performed by spine surgeons, interventional radiologists, or pain medicine specialists trained in image-guided spinal procedures.

What Are Vertebroplasty and Kyphoplasty?

Both vertebroplasty and kyphoplasty are minimally invasive procedures, meaning they are performed through small skin punctures rather than open surgery. In both, a thin needle is guided into the fractured vertebra using live X-ray imaging called fluoroscopy. A type of medical bone cement, usually polymethylmethacrylate (PMMA), is then injected into the broken bone. The cement hardens within minutes, stabilising the fracture from the inside.

The key idea is that a stable fracture hurts less. Once the broken pieces of bone can no longer move against each other, the pain usually decreases. Many patients also find it easier to stand, walk, and sleep within a short time after the procedure, though responses vary.

The difference between the two procedures lies in how the cement is delivered:

• Vertebroplasty injects cement directly into the cracked vertebra, filling the spaces in the broken bone.
• Kyphoplasty first uses a small balloon to create a cavity inside the collapsed vertebra, and in many cases to partially restore its height, before the cement is injected into that cavity.

Both are typically day-care procedures, often performed under local anaesthesia with sedation, although general anaesthesia is sometimes used. Most patients go home the same day or after a single overnight stay.

Why Are Vertebroplasty and Kyphoplasty Performed?

The main goal of vertebral augmentation is to relieve the pain of a vertebral compression fracture and to stabilise the spine. The most common reasons a doctor may consider these procedures include:

• Osteoporotic compression fractures. Osteoporosis is a condition in which bones become thin and fragile. The vertebrae can fracture from minor stresses such as coughing, bending, or a simple fall. These are the most common reason vertebroplasty and kyphoplasty are performed.
• Cancer-related fractures. Some cancers, particularly multiple myeloma and cancers that have spread to bone (metastatic cancer from breast, lung, prostate, or other primary sites), weaken the vertebrae and can cause them to collapse.
• Vertebral haemangiomas. These are non-cancerous growths in the vertebra that, in rare cases, can become painful or weaken the bone.
• Traumatic fractures in selected cases. In a patient with otherwise healthy bone, vertebral augmentation is less commonly used for trauma, but it may be considered for certain stable fractures.

It is important to understand what these procedures do not do. They do not cure osteoporosis or cancer. They do not prevent another vertebra from fracturing in the future. They treat this fracture, in this bone, at this time. Long-term care of the underlying bone disease is a separate and equally important part of treatment.

Who Is a Candidate?

Not everyone with back pain or even with a vertebral fracture needs vertebroplasty or kyphoplasty. Many compression fractures heal on their own with rest, pain medication, bracing, and time. Doctors typically consider vertebral augmentation when:

• The fracture is causing significant pain that has not responded to several weeks of non-surgical treatment, such as pain medications, activity modification, and bracing.
• The fracture is recent — usually within the past few weeks to a few months — and imaging shows that the bone is still healing (often described as “active” or showing oedema on MRI).
• The pain is clearly coming from the fractured vertebra, confirmed by examination and imaging.
• The patient is medically able to tolerate the procedure and lie face down on a procedure table for the time it takes.

Doctors typically avoid vertebral augmentation when:

• There is an active infection at the planned puncture site or in the spine.
• The fracture is causing pressure on the spinal cord or nerves with neurological symptoms such as leg weakness, numbness, or loss of bowel or bladder control. These situations usually need a different surgical approach.
• The vertebra is so destroyed that there is not enough bone to hold the cement.
• There is a serious bleeding disorder that cannot be corrected.
• The patient has a known allergy to the bone cement or contrast dye used during the procedure.

Whether vertebroplasty or kyphoplasty is appropriate for any one patient is a clinical decision based on the type and age of the fracture, MRI findings, overall health, and pain pattern.

Alternatives to Consider

Many vertebral compression fractures are first treated without any procedure. Doctors commonly try non-surgical management for a defined period, often four to six weeks, before considering vertebral augmentation. Non-surgical options include:

Rest and gradual return to activity

Short periods of relative rest are common in the first days after a fracture. Prolonged bed rest is generally avoided, because long inactivity weakens muscles further and increases the risk of blood clots, pneumonia, and worsening osteoporosis.

Pain medication

Doctors may prescribe paracetamol, anti-inflammatory drugs, short courses of stronger pain medication, or a medication called calcitonin, which has been used for vertebral fracture pain in some patients. The choice depends on the patient’s other health conditions.

Bracing

A back brace can support the spine, limit painful movement, and help a fracture heal. Braces vary from soft supports to more rigid designs depending on the fracture.

Physical therapy

Once the worst pain settles, gentle physiotherapy helps rebuild strength in the muscles that support the spine and reduces the risk of falls and further fractures.

Treatment of the underlying bone disease

For patients with osteoporosis, medications such as bisphosphonates, denosumab, teriparatide, romosozumab, and others can significantly reduce the risk of future fractures. Calcium and vitamin D adequacy is checked and treated as needed. For cancer-related fractures, the underlying cancer is treated by an oncology team, and bone-strengthening medications may also be used.

Open spine surgery

In a smaller number of cases — for example, when the fracture is unstable, when the spinal cord is being compressed, or when there is significant deformity — a more extensive open operation, such as decompression with fusion, may be needed instead of, or in addition to, vertebral augmentation.

The choice between continuing non-surgical care and proceeding with a procedure is one of the key conversations to have with your spine specialist.

Types of Vertebral Augmentation

Vertebroplasty and kyphoplasty are closely related but not identical. Understanding what each one does, and how they differ, helps make sense of why your doctor may suggest one over the other.

Vertebroplasty

Vertebroplasty was the original procedure, developed in the 1980s. The doctor inserts one or two needles into the fractured vertebra under live X-ray guidance, usually entering through the back. Bone cement, in a paste-like consistency, is injected slowly into the bone. As the cement hardens, it fills the cracks in the broken vertebra and stabilises it.

Vertebroplasty does not actively try to restore the height of the collapsed bone. Whatever shape the vertebra is in when the cement enters is largely the shape it stays in. The procedure usually takes around 30 to 60 minutes for a single level.

Kyphoplasty

Kyphoplasty, sometimes called balloon kyphoplasty, was developed later as a variation on the original idea. It uses the same overall approach — needle into the vertebra under X-ray, followed by cement — but adds an extra step. After the needle is placed, a small balloon is passed through it and inflated inside the vertebra. The balloon does two things: it creates a cavity inside the bone, and in many cases it pushes the collapsed parts of the vertebra outward, partially restoring height and reducing the forward curve (kyphosis) that compression fractures can cause.

Once the balloon is deflated and removed, cement is injected into the cavity it created. Because the cement is filling a defined space, it can be injected at a thicker consistency and under lower pressure, which some specialists feel reduces the risk of cement leaking out of the bone.

How doctors choose between the two

The choice depends on several factors:

• How collapsed the vertebra is. If there is significant loss of height and forward angulation, doctors may favour kyphoplasty because of its potential to partially restore vertebral shape.
• How recent the fracture is. Both procedures work best on fractures that are still relatively fresh; older, healed fractures rarely respond.
• The nature of the bone. In cancer-related fractures, where bone may be more destroyed, balloon use may help create a contained space for cement.
• Operator experience and preference. Some centres perform mostly kyphoplasty; others perform both, and choose case by case.

Studies comparing the two procedures generally find that both relieve pain effectively in carefully selected patients. Differences in long-term outcomes, height restoration, and cement leakage rates have been studied, with kyphoplasty showing some advantages in cement containment and height correction, and vertebroplasty being a simpler and shorter procedure. There is no single right answer for every patient.

Preparing for the Procedure

Preparation usually starts a few days to a few weeks before the procedure is scheduled. Your team will guide you through the specific steps, but typical preparation includes:

Imaging

Most patients will have already had X-rays and an MRI of the spine. The MRI is particularly important because it shows whether the fracture is recent and still healing — the situation in which vertebral augmentation is most likely to help. In some cases, a CT scan is also performed to plan needle placement. If MRI is not possible (for example, in a patient with certain implants), a bone scan may be used instead.

Medical review

Your doctors will review your overall health, medications, and any allergies. Blood tests usually include a complete blood count and clotting tests. Blood-thinning medications such as warfarin, aspirin, clopidogrel, or newer anticoagulants may need to be paused for a defined number of days before the procedure, on the instruction of the prescribing doctor.

Fasting

You will usually be asked not to eat or drink for several hours before the procedure, especially if sedation or general anaesthesia is planned.

Skin and infection check

Any skin infection or other active infection will need to be treated before the procedure to reduce the risk of carrying germs into the spine.

Practical preparation at home

Because most patients go home the same day or the next, it helps to arrange:

• A ride home from a family member or friend, since you should not drive immediately after sedation.
• A comfortable place to rest with easy access to the bathroom.
• Loose-fitting clothes that are easy to put on without bending.
• Help with shopping, cooking, or childcare for the first few days.

What Happens During the Procedure

The day-of experience is similar for both vertebroplasty and kyphoplasty.

Arrival and setup

After check-in and a final review with the team, you will change into a gown. An intravenous line is placed for fluids and medications. Monitors are attached for your heart rhythm, blood pressure, and oxygen level.

Positioning and anaesthesia

You will usually lie face down on a special padded table designed for spine procedures. The team will adjust pillows under your chest and hips to keep your spine in a comfortable position. Most vertebral augmentation procedures are done under local anaesthesia combined with intravenous sedation, which keeps you relaxed and comfortable but breathing on your own. In some cases, general anaesthesia is used, particularly for very anxious patients or when multiple levels are being treated.

Needle placement

The skin over your back is cleaned with antiseptic and covered with sterile drapes. The doctor uses live X-ray imaging to identify the fractured vertebra. Local anaesthetic is injected at the skin and deeper tissues. A small puncture, usually only a few millimetres, is made.

The balloon step (kyphoplasty only)

If kyphoplasty is being performed, a deflated balloon is passed through the needle into the vertebra and gradually inflated. The pressure is carefully controlled. Once the desired cavity has been created and any height restoration achieved, the balloon is deflated and removed.

Cement injection

Bone cement is mixed at the table; it has a working window of several minutes before it hardens. The cement is injected slowly through the needle into the vertebra, with constant X-ray monitoring. The doctor watches carefully for any sign of cement moving outside the bone. Once enough cement has been delivered, the injection is stopped and the cement is allowed to set.

Finishing up

The needles are removed. The puncture sites are so small that they usually do not need stitches; a simple dressing is applied. The whole procedure typically takes 30 to 90 minutes for a single level, longer if multiple vertebrae are treated.

You are then turned onto your back, woken up if sedated, and taken to a recovery area. Most patients are asked to lie flat for one to two hours while the cement fully hardens and to allow observation.

Recovery and Healing

The first 24 hours

After the bed rest period in the recovery area, you will be helped to sit up, then to stand and walk a short distance. Walking soon after the procedure helps prevent blood clots and stiffness. You will be given pain medication as needed; some soreness at the puncture sites is normal, even if the fracture pain has improved.

Most patients go home the same day or after one overnight stay. You should not drive yourself home.

The first week

During the first few days at home, doctors typically advise gradually increasing activity rather than strict bed rest. Light walking is encouraged. Heavy lifting, vigorous exercise, and significant bending or twisting are usually avoided. The puncture sites should be kept clean and dry as instructed; small dressings are usually removed after one or two days.

If a brace was being used before the procedure, your doctor will advise whether to continue it. Some teams use a brace for a defined period after the procedure; others stop bracing once the fracture is stabilised by cement.

The first month

Most patients are back to comfortable walking and most daily activities within a few weeks. Physical therapy is often started during this period, focusing on:

• Posture and safe movement (avoiding deep bending and twisting).
• Strengthening of the back and core muscles.
• Balance training to reduce fall risk.
• Gentle aerobic exercise such as walking.

Longer-term recovery

The cemented vertebra is structurally stable from the moment the cement hardens. However, full recovery — rebuilding lost muscle strength, improving balance, returning to normal activity — usually takes weeks to a few months. The vertebrae above and below the treated level continue to be vulnerable to fracture if the underlying bone disease is not addressed, which is why bone-strengthening treatment is a central part of the longer plan.

Risks and Complications

Vertebroplasty and kyphoplasty are generally considered safe procedures when performed by experienced specialists in carefully selected patients. Serious complications are uncommon but not zero. Reported risks include:

• Cement leakage. Small amounts of cement leaking outside the vertebra are not unusual on imaging and are most often harmless. Larger leaks, however, can press on nerves or the spinal cord, or enter blood vessels. Symptomatic leaks are uncommon but can be serious. Kyphoplasty’s use of a balloon-created cavity is thought to lower the risk of significant leakage.
• Infection. As with any procedure that enters the body, infection of the puncture site, the bone, or the surrounding tissues can occur. This is rare.
• Bleeding or bruising at the puncture site.
• Allergic reactions to the cement, contrast dye, or medications.
• Nerve injury. Rare, but possible if a needle or leaked cement contacts a nerve root.
• Pulmonary cement embolism. Very small particles of cement can occasionally travel through veins to the lungs. Most of these are not noticed by the patient. Larger emboli are rare but can be serious.
• New fractures at nearby vertebrae. Patients with osteoporosis have a meaningful baseline risk of further fractures, and whether vertebral augmentation itself slightly increases this risk has been debated in the medical literature. Either way, treating the underlying bone disease is essential.
• Failure to relieve pain. Some patients do not get the pain relief they hoped for. This is more likely if the fracture is old, if the pain was not actually coming from the treated vertebra, or if there are other sources of back pain.
• Anaesthesia-related risks if sedation or general anaesthesia is used.

Your team will discuss your individual risk factors as part of consent.

Life After Vertebroplasty or Kyphoplasty

The procedure treats one fracture. Living well after vertebral augmentation involves looking after the spine as a whole and addressing the underlying reason the bone fractured in the first place.

Treating the underlying bone disease

For most patients, this means a structured plan for osteoporosis. Major societies including the International Osteoporosis Foundation emphasise that a vertebral fracture is a strong sign of fragile bone, and that anti-osteoporosis medication, calcium and vitamin D adequacy, and lifestyle measures should be reviewed and optimised. Bone-strengthening medications used in this setting include bisphosphonates, denosumab, teriparatide, and others, chosen based on the individual’s fracture risk and other health conditions.

For cancer-related fractures, the oncology team continues to direct treatment of the underlying cancer, with bone-targeted medications and radiotherapy considered as appropriate.

Falls prevention

Many vertebral fractures happen with minor falls. Reducing the risk of falls is a key part of long-term care:

• Removing trip hazards at home (loose rugs, poor lighting, cluttered passageways).
• Vision and hearing checks.
• Reviewing medications that can cause dizziness or drowsiness.
• Balance and strength exercises, often guided by a physiotherapist.
• Use of a cane or walker when appropriate, without embarrassment.

Exercise and posture

Once cleared by your team, regular weight-bearing exercise (walking, gentle resistance training) and posture-friendly movement help protect the spine. High-impact activities and movements that involve forceful bending or twisting may be avoided depending on individual situation.

Nutrition

Adequate protein, calcium, and vitamin D support bone health. Your doctor may check blood vitamin D levels and recommend supplements where appropriate.

Watching for new fractures

Sudden new back pain, especially in someone with osteoporosis or cancer, can mean a new compression fracture. Worsening forward curvature of the upper back, loss of height, or new pain that does not settle within a few days warrants medical review. Most new fractures do not cause neurological symptoms, but new leg weakness, numbness, or loss of bowel or bladder control is a red flag and needs urgent attention.

Frequently Asked Questions

How soon will my pain improve after vertebroplasty or kyphoplasty?

Many patients notice meaningful pain relief within one to two days, although some take a week or more. A smaller number do not get the relief they hoped for, particularly if the fracture is older or if other sources of back pain are present. Your team can give you a personalised estimate based on your imaging and symptoms.

Will I need to stay in hospital?

Most patients are treated as a day case or after a single overnight stay. Longer admission may be needed if there are other health concerns or if multiple vertebrae are treated.

What is the difference between vertebroplasty and kyphoplasty in plain terms?

Both inject bone cement into a broken vertebra to stabilise it. Vertebroplasty injects the cement directly. Kyphoplasty first uses a small balloon to create a cavity in the bone and to try to partially restore the bone’s height, and then injects cement into that cavity.

Does the cement stay in the bone forever?

Yes. The bone cement (polymethylmethacrylate) is a permanent material. It hardens within minutes and remains in the vertebra long-term.

Can I have an MRI after vertebroplasty or kyphoplasty?

Yes. The cement does not contain metal in a form that prevents MRI. Future MRI scans are possible if needed.

Can the same vertebra be treated again?

It is uncommon. Once a vertebra is stabilised with cement, repeating the procedure on the same level is rarely useful. However, new fractures at other vertebrae can be treated if appropriate.

Will the procedure prevent future fractures?

No. Vertebral augmentation treats the fractured vertebra. Preventing future fractures depends on treating the underlying bone disease — usually osteoporosis — with medication, calcium and vitamin D, exercise, and falls prevention.

Are these procedures used for cancer in the spine?

Yes. Vertebroplasty and kyphoplasty are used for painful vertebral fractures caused by cancer that has spread to bone, and for conditions such as multiple myeloma. They are part of a wider cancer care plan led by an oncology team.

Is the procedure painful?

Local anaesthesia and sedation usually make the procedure comfortable. Some pressure may be felt as the needle is placed or as cement is injected. Mild puncture-site soreness for a few days afterwards is common.

When can I drive again?

Driving is usually avoided for at least 24 hours after sedation and until you can move comfortably and react quickly. Your team will give specific advice based on your situation.

Conclusion

Vertebroplasty and kyphoplasty are minimally invasive procedures that can offer meaningful pain relief and stability for a painful vertebral compression fracture. They are most useful when the fracture is recent, the pain is severe and not responding to other treatments, and the imaging confirms an active healing fracture. Vertebroplasty injects cement directly into the broken bone; kyphoplasty first uses a balloon to create a cavity and partially restore vertebral height. Both procedures share similar risks and similar benefits in carefully chosen patients, and the choice between them is made by your spine specialist based on your fracture, your bones, and the team’s experience.

Equally important is what happens after the procedure: addressing osteoporosis or the underlying cause of the fracture, reducing falls, staying active, and watching for new fractures. The procedure stabilises today’s broken vertebra; the longer plan protects tomorrow’s. Discussing both with your doctors helps you walk into the procedure, and out of it, with a clear understanding of what to expect.