Vertebroplasty and Kyphoplasty

Vertebral fractures that result from osteoporosis are termed Osteoporotic Vertebral Fractures.
Osteoporotic Vertebral Compression Fractures are very common fragility fractures of the spine that affect up to 50% of people over 80 years old.

The signs and symptoms can vary depending on the severity of the condition. Some may not experience any symptoms at all.

Symptoms may include:

  • Back pain: A quarter of these fractures are painful, with the pain at the fracture area or radiating along the nerves.
  • Kyphosis: They can also cause loss of height and a stooped posture, known as kyphosis or dowager's hump.
  • Spinal cord compression: Rare
  • Reduced mobility

What is Vertebroplasty?

Vertebroplasty is a minimally invasive surgical procedure wherein a small needle is inserted into the fractured vertebra under X-ray guidance. A special type of cement is injected into the vertebra to stabilize it and reduce pain. The cement hardens quickly, providing immediate support to the fractured bone.
Vertebroplasty has been shown to be effective in reducing pain and improving function in individuals with vertebral fractures, although it may not be appropriate for all cases.

What is Kyphoplasty?

Kyphoplasty is a minimally invasive surgical procedure used to treat vertebral fractures, particularly those caused by osteoporosis. During the procedure, a small balloon is inserted into the fractured vertebra under X-ray guidance and inflated to create a space in the bone. The space is then filled with a special cement to stabilize the vertebra and reduce pain. The cement hardens quickly, providing immediate support to the fractured bone.
Kyphoplasty has been shown to be effective in reducing pain and improving function in individuals with vertebral fractures, although it may not be appropriate for all cases.

When are Vertebroplasty and Kyphoplasty performed?

Conservative measures such as rest, medication, and bracing are typically used to treat vertebral body compression fractures.

However, when patients have difficulty tolerating these treatments, vertebroplasty or kyphoplasty may be recommended.

This is especially true for patients with uncontrolled pain, conditions that limit their ability to rest or take medication, elderly or frail, or having a compression fracture caused by a malignant tumour or osteoporosis. Nonetheless, it is important to note that these treatments have limitations. Some of the pain experienced may be due to muscle spasms resulting from spinal deformity or pain from the facet joints in the lower back.

What happens before Vertebroplasty and Kyphoplasty?

Before the procedure, the patient will typically undergo a thorough evaluation by a specialist to determine the underlying cause of their pain and whether Vertebroplasty or Kyphoplasty is an appropriate treatment option.

This evaluation may include a physical exam, medical history review, and diagnostic tests such as imaging studies (e.g., X-rays, MRI, and CT scans).

If the specialist determines that procedure is appropriate, the patient will typically receive instructions on preparing for the procedure. This may include:

  • Discontinuing the use of blood-thinning medications, such as warfarin, for a specified period before the procedure
  • Do not stop any medication before talking to us.
  • Arranging for someone to drive them home after the procedure.
  • Inform us of any allergies, medications, or medical conditions you have. If there is an active infection, the procedure is not carried out.

What happens during the procedure?

The procedure for vertebroplasty or kyphoplasty usually involves administering a general anaesthetic to the patient, who will be lying on their stomach.

The back will be cleaned, and a small incision will be made on one or both sides of the midline for treating each vertebra. A hollow needle will be inserted through the muscle and into a bony passage called the pedicle, which goes from the back of the spine to the front of the vertebral body. Video X-ray guidance is used to direct the needle into the appropriate area, and multiple X-rays are taken from various angles to ensure proper placement of the needle.

For vertebroplasty, liquid cement is injected into the vertebra through the needle, and additional X-rays are taken to monitor the movement of the cement. The cement will harden within minutes.

In the kyphoplasty procedure, a balloon is initially placed into the fractured vertebrae through the hollow needle to form a cavity or space. The balloon is then extracted, and the liquid cement is inserted into the cavity created by the balloon. Several X-rays are taken to track the cement's movement into the vertebra, and the cement solidifies in a matter of minutes.

What can I expect after the procedure?

After the vertebroplasty or kyphoplasty procedure, you will be taken to the recovery ward, where nurses will monitor your blood pressure and pulse.

If you experience any discomfort, the nursing staff will provide appropriate medication to alleviate it. Once you are fully conscious and comfortable, you can get out of bed, which may be the same day. If you do not require any additional treatment, you will likely be discharged the following day once your mobility has been assessed and approved by your physiotherapist.
It is recommended that you have someone collect you, as driving or taking public transport is not recommended for at least 48 hours after the anaesthesia.
Your specialist will determine whether you need to attend a follow-up clinic, and you can contact the nurse specialist or your consultant’s team if you have any concerns before your next appointment.

What are the potential side effects of the procedure?

Like all interventions, some potential risks are associated with vertebroplasty or kyphoplasty.
Complications may include bleeding, infection, blood clots, and adverse reactions to anaesthesia. Specific complications that may arise from the procedure include the bone cement leaking into nearby soft tissues or veins and potential damage to the spinal cord or spinal nerves, resulting in numbness or paralysis. The incidence of neurological complications is low.

All the risks and benefits will be discussed during the consent process.
Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results, and other important medical information that pertains to the Vertebroplasty/Kyphoplasty procedure.

Please follow the BASS (British Association of Spinal Surgeons) website for more information.

Learn more about spinal condition:

Osteoporotic Fractures: Explore the relationship between osteoporosis and the risk of spinal fractures.