Vertebroplasty and Kyphoplasty: Overview

Surgeries to treat spinal compression fractures

In This Article

Vertebroplasty and kyphoplasty are surgical procedures that involve restoring the integrity of fractured vertebrae with cement injections. Such fractures most commonly occur as a result of bone weakening from osteoporosis and can result in severe, persistent pain and disability. Both methods of vertebral augmentation with only a slight difference in how they are done, these two procedures share common goals: improve symptoms and quality of life.

Surgeons hands operating on a patient
tunart / Getty Images

What Are Vertebroplasty and Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive surgical procedures performed under general anesthesia in an outpatient facility.

Both vertebroplasty and kyphoplasty involve the injection of a type of cement called polymethylmethacrylate (PMMA) into fractured bone in the spinal column.

While the terms are often used interchangeably, kyphoplasty is really a subtype of vertebroplasty. It is distinguished by the fact that it involves an additional step of inserting and inflating a balloon before the cement injection. This creates a cavity that helps restore the vertebrae to its pre-fracture shape and height.

Both surgeries are performed with the help of fluoroscopy, a type of medical imaging technique in which an X-ray beam is passed through the body. Fluoroscopy helps guide the surgeon as they operate.

Kyphoplasty is overall performed more commonly than vertebroplasty and is associated with a lower complication rate. Nevertheless, research does not suggest that one procedure is more effective in terms of reducing pain and disability than the other.

These scheduled procedures are almost always performed on adults; rarely, they may be performed on a child. Most patients go home the same day after either procedure.

Contraindications

Absolute contraindications to vertebroplasty or kyphoplasty include:

  • Asymptomatic vertebral fracture or fracture that improves with conservative measures (e.g., rest and pain medication)
  • An uncontrolled bleeding disorder
  • An allergy to bone cement
  • A tumor that involves the spinal canal
  • Local (vertebral body) or a generalized infection

Additional contraindications include back pain unrelated to a vertebral fracture, such as a disc herniation or spinal stenosis. Imaging tests, like a magnetic resonance imaging (MRI) of the spine, can help doctors confirm a diagnosis.

Potential Risks

Vertebroplasty and kyphoplasty are generally considered safe, low-risk procedures. However, in some instances, serious complications may occur.

These complications include: 

  • Infection
  • Bleeding
  • Cement (PMMA) leaking, which may result in pain, tingling, numbness, or weakness (more common for vertebroplasty than kyphoplasty)

Rare complications include:

  • Pulmonary embolism from cement particles traveling to the lung
  • Spinal stenosis from cement leaking into the epidural space
  • Nerve root or spinal cord damage resulting in paralysis (extremely rare)

Purpose of Vertebroplasty and Kyphoplasty

The purpose of vertebroplasty and kyphoplasty is to alleviate pain and improve mobility in patients with disabling vertebral fractures. Kyphoplasty can also help restore some or all of the height of the bone and, therefore, improve spine alignment.

Most commonly, these procedures are used to treat compression fractures that result from osteoporosis. Less commonly, the procedures are used to treat fractures that result from cancer, trauma, or osteonecrosis. 

How to Prepare

If you have decided to undergo vertebroplasty or kyphoplasty, your doctor will provide various pre-operative instructions.

These instructions may include:

What to Expect on the Day of Surgery

With both vertebroplasty and kyphoplasty, bone cement is injected into the fractured vertebrae. Kyphoplasty also includes creating a cavity with a special balloon.

For kyphoplasty, you can expect the following steps to occur on the day of your surgery:

  • Upon arrival, you will change into a hospital gown and a nurse will place an IV.
  • You will be taken to an operating room where you will lie face down on the table.
  • An anesthesiologist will give you medication to put you to sleep.
  • The surgeon will make a small incision (cut) over the area of the fractured vertebrae.
  • Using X-ray guidance, the surgeon will insert a special instrument called a trocar (a needle surrounded by a narrow tube) into one side of the fractured vertebrae.
  • A special balloon will be inserted through the trocar and inflated to create an open cavity inside the bone.
  • Once the new cavity is created, the balloon is deflated and removed.
  • The surgeon will inject the bone cement into the cavity and close the incision site.
  • You will continue to lie on the operating table until the cement hardens (this takes a few minutes).

After the procedure, which lasts less than an hour, you will be taken to a recovery room. Once the anesthesia has worn off, most patients are able to go home.

Recovery

Before you leave the surgical center, your doctor will provide you with various instructions to follow at home, such as:

  • Applying ice to your back (as needed) for any soreness related to the procedure
  • Returning to normal activities (usually right away) and avoiding strenuous activities for a period of time (usually six weeks)
  • Following up with your doctor for osteoporosis management, if that was the cause of your fracture

Some patients experience immediate pain relief after vertebroplasty or kyphoplasty. For others, pain relief usually occurs within a few days of the procedure.

Long-Term Care

Vertebral fractures are common, especially in postmenopausal women, in whom osteoporosis is also common. Due to the potentially severe, disabling pain associated with these fractures, it's sensible to take steps to prevent another from occurring.

Prevention of osteoporosis-related vertebral fractures entails engaging in various non-pharmacologic therapies, including:

  • Performing daily weight-bearing exercises
  • Ensuring adequate calcium intake and vitamin D supplementation
  • Stopping smoking
  • Moderating alcohol intake
  • Addressing strategies to prevent falls (e.g., avoiding high-risk medications, correcting vision problems, etc.)

In some cases, an osteoporosis medication such as a bisphosphonate may be indicated.

A Word From Verywell

Even though scientific data comparing vertebroplasty/kyphoplasty to placebo (a sham procedure) has not demonstrated a robust clinical benefit, many medical professionals still utilize these procedures in treating severe and persistent pain related to acute osteoporotic vertebral fractures.

If you (or a loved one) are considering a vertebroplasty/kyphoplasty, do your due diligence and weigh the possible risks and benefits with your personal doctor.

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Article Sources
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