Vertebral Augmentation (Kyphoplasty and Vertebroplasty)

Overview

Vertebral augmentation is a minimally invasive way to treat a painful vertebral compression fracture by injecting medical bone cement directly into the fractured bone, using a needle placed through the skin under X-ray guidance. There are two related versions of this procedure. Vertebroplasty injects cement straight into the collapsed vertebra to stabilize it from the inside. Kyphoplasty adds a preliminary step, a small balloon is inflated inside the vertebra first to create a cavity and press the collapsed bone outward, before the balloon is removed and cement is placed into the space it made.

Both procedures share the same basic goal, to reduce the motion of tiny fracture fragments that causes pain when a fractured vertebra flexes under load, by essentially casting it from the inside with hardened cement. Neither procedure repairs the underlying cause of the fracture, most often osteoporosis, so they are always paired with treatment of the bone disease itself.

When it's recommended

Vertebral augmentation is generally considered for patients with a confirmed acute or subacute compression fracture, seen as bone marrow edema on MRI, whose pain is severe, matches the level of the fracture on exam, and has not adequately responded to four to six weeks of conservative care such as pain medication, activity modification, and sometimes a brace. It is not appropriate for every compression fracture. Many fractures, especially mild ones, heal well with time and non-surgical treatment alone, and augmentation is reserved for patients whose pain remains disabling despite an honest trial of that approach.

Certain fracture patterns and conditions make augmentation unsuitable or unsafe, including a burst fracture with bone pushed into the spinal canal, a breach of the back wall of the vertebra, spinal instability, nerve compression from the fracture itself, active infection, or a fracture that is old and already healed. When a fracture is linked to cancer or infection rather than osteoporosis, augmentation may still play a role, but only as part of a broader, condition-specific treatment plan decided with the treating specialists.

How it works

The procedure is typically done with the patient lying face down, under local anesthesia with sedation or general anesthesia. Using continuous X-ray guidance, the physician places one or two thin needles through the pedicles, the bony bridges on either side of the vertebra, into the fractured vertebral body. In kyphoplasty, a small balloon is threaded through the needle and slowly inflated to compact the surrounding bone and create a defined cavity, which can also help push the collapsed vertebra back toward its original height, then the balloon is removed. In vertebroplasty, this balloon step is skipped entirely.

In both procedures, a thick cement, most often acrylic bone cement, is then injected slowly into the vertebra under live imaging so the physician can watch for any cement heading toward the spinal canal, a blood vessel, or the disc space and stop immediately if it does. The cement hardens within minutes, stabilizing the fracture from the inside. The whole procedure usually takes about thirty minutes to an hour for a single level, and multiple levels can sometimes be treated in one session.

Preparing for the procedure

Preparation includes recent MRI confirming an active, unhealed fracture that matches the painful level, routine pre-procedure blood work and anesthesia clearance, and a review of medications, since blood thinners and certain supplements usually need to be paused beforehand under a physician's direction. Patients are asked to arrange a ride home, since sedation or general anesthesia is used, and to fast for several hours beforehand per the anesthesia team's instructions. It also helps to plan for someone to assist at home for the first day or two, even though recovery is generally fast.

Recovery and aftercare

Many patients notice meaningful pain relief within a day or two, and the procedure is often done on an outpatient basis or with a single overnight stay. Walking is usually encouraged soon after the procedure, and most patients can resume light daily activities quickly, though heavy lifting, bending, and twisting are typically restricted for several weeks while other tissues settle. A short course of pain medication may still be needed as residual soreness from the needle sites and any pre-existing muscle strain resolves.

Because augmentation treats only the fracture itself, ongoing osteoporosis management, including calcium, vitamin D, weight-bearing activity as tolerated, and bone-directed medication, should continue or begin promptly afterward. This is one of the most effective ways to lower the risk of another fracture at a different level.

Risks and considerations

Cement leakage is the most common technical issue, occurring in a meaningful proportion of procedures, most often into the disc space above or below where it is usually harmless. Leakage toward the spinal canal or into a blood vessel is far less common but can occasionally irritate a nerve or, rarely, cause more serious problems, which is why the procedure is done under continuous imaging with the ability to stop the injection at any sign of unwanted spread. Kyphoplasty's balloon-created cavity generally allows cement to be placed at lower pressure, and some evidence suggests this modestly lowers leakage rates compared with vertebroplasty, though pain relief between the two techniques is broadly similar.

A separate and important consideration is adjacent-level fracture, the concern that stiffening one vertebra with cement shifts mechanical load onto the vertebrae immediately above and below it, potentially raising their fracture risk over time. This risk appears to be higher when cement leaks into the adjoining disc space or when height restoration is aggressive, and it underscores why augmentation is offered selectively rather than routinely, and why treating the underlying bone disease afterward is not optional. Other risks, common to any needle-based spine procedure, include infection, bleeding, and rarely, nerve injury. Any of the red-flag symptoms above after the procedure should prompt urgent medical evaluation.