Vertebroplasty/Kyphoplasty

Vertebroplasty and kyphoplasty are minimally invasive spine procedures in which a special medical-grade cement is injected into a cracked or collapsed vertebra (one of the small bones that make up the spine) to stabilise it and relieve pain.

In vertebroplasty, the cement is injected directly into the damaged vertebra through a thin needle. In kyphoplasty, a small balloon is first inflated inside the vertebra to create a space and, when possible, restore some of the bone's original height before the cement is placed. Once the cement hardens — usually within minutes — it acts like an internal splint, stopping the broken bone from moving and pressing on surrounding nerves.

These procedures are used when a vertebral compression fracture (VCF) — a collapse of one or more spinal bones — is causing significant pain or disability, and conservative treatments such as bed rest, pain medication, or a back brace have not provided enough relief. The most common reasons a doctor may recommend vertebroplasty or kyphoplasty include:

• Osteoporosis (thinning and weakening of the bones) that has led to one or more vertebrae collapsing, often after a minor fall or even without any injury
• Pathological fracture, meaning a vertebra that has broken because it was weakened by a tumour — particularly a condition called multiple myeloma (a blood cancer that affects bones) or a metastatic tumour (cancer that has spread to the spine from elsewhere in the body)
• Vertebral fracture caused by long-term use of steroid medications, which can weaken bone over time
• Haemangioma (a benign, non-cancerous cluster of blood vessels inside a vertebra) that is causing pain or instability

These procedures are generally not suitable in certain situations. A doctor will review each patient's imaging and health history carefully before recommending them. Situations where they are usually avoided include:

• Fractures that are already healing well and not causing significant pain
• Significant spinal cord compression (when the spinal cord itself is severely squeezed), which may require open surgery instead
• Active infection in or near the spine
• Bleeding disorders or the inability to safely pause blood-thinning medications
• Allergy to the bone cement or contrast dye used during the procedure
• Fractures involving the back wall of the vertebra in a way that raises the risk of cement leaking into the spinal canal

Vertebroplasty and kyphoplasty are considered low-risk procedures compared to open spine surgery, but like any medical intervention they carry some potential complications. Your doctor will weigh these against the likely benefits for your specific situation. Recognised risks include:

• Cement leakage — the most common concern; a small amount of cement can seep out of the vertebra into nearby tissues or veins. This usually causes no symptoms, but in rare cases it can press on a nerve or travel to the lungs
• Increased pain or new pain at or near the treated level, sometimes temporary as the bone heals
• Fracture of an adjacent vertebra (a neighbouring spinal bone), which can occur because the newly stabilised vertebra changes the load on the bones next to it
• Infection at the needle entry site or, very rarely, inside the spine
• Bleeding at the needle entry site
• Allergic reaction to the contrast dye used to guide the needle under X-ray
• Nerve or spinal cord irritation if cement leaks close to neural structures — this is uncommon but requires prompt attention
• Rare risk of blood clot forming in a vein (deep vein thrombosis) due to reduced mobility around the time of the procedure

Good preparation helps the procedure go smoothly and reduces the chance of complications. Your medical team will give you personalised instructions, but the following describes what is typically expected.

Before the procedure, your doctor will usually ask you to fast (not eat or drink) for a set number of hours, as sedation or general anaesthesia may be used. If you take blood-thinning medications (such as anticoagulants or antiplatelet drugs), your doctor will decide whether and when to pause them. Smoking and alcohol are generally discouraged in the days before the procedure because they can affect healing and anaesthesia. Inform your team about all supplements and herbal remedies you take, as some can affect bleeding.

Your doctor will typically order several tests beforehand to plan the procedure and check that it is safe for you. These commonly include:

• MRI (magnetic resonance imaging) or CT (computed tomography) scan of the spine to confirm which vertebra is fractured and assess whether the fracture is recent and likely to benefit from the procedure
• Bone density scan (DEXA scan) if osteoporosis is suspected
• Blood tests to check clotting ability, kidney function, and general health
• EKG (electrocardiogram, a heart tracing) and chest X-ray if required by the anaesthesia team
• A review of any previous imaging, such as earlier MRIs or CT scans

On the day, the procedure itself typically follows these steps, though the exact sequence and technique may vary between hospitals and surgeons:

• 1. You are positioned face-down on the procedure table.
• 2. A sedative or local anaesthetic (numbing medicine) is given — some patients receive general anaesthesia (fully asleep), depending on their condition and the hospital's practice.
• 3. The skin over the target area of the back is cleaned and a sterile drape is placed.
• 4. Using live X-ray guidance (fluoroscopy) or CT imaging, the surgeon precisely positions a hollow needle through the skin and into the fractured vertebra.
• 5. In kyphoplasty only: a small balloon is passed through the needle and inflated carefully to create a cavity and partially restore vertebral height, then deflated and removed.
• 6. Medical-grade bone cement is slowly injected through the needle to fill the space. The surgeon watches in real time to make sure the cement stays within the vertebra.
• 7. The needle is withdrawn once the cement begins to set.
• 8. A small dressing is applied to the needle entry point — no stitches are usually needed.
• 9. You are moved to a recovery area for monitoring.

Recovery from vertebroplasty or kyphoplasty is generally faster than recovery from open spine surgery. Most patients are monitored for a few hours after the procedure before being assessed for discharge; some may stay overnight, depending on their overall health and how they feel. Pain relief often begins within hours to days, though individual results vary and your medical team will monitor your progress closely.

• Rest: you will usually be asked to lie flat for a short period immediately after the procedure, then gradually move to sitting and standing under the guidance of nursing staff
• Activity restrictions: strenuous lifting, bending, and twisting movements are typically restricted for several weeks; your doctor or physiotherapist (a movement and rehabilitation specialist) will advise a gradual return to activity
• Pain management: some temporary soreness at the needle entry site is common; your doctor will advise on appropriate pain relief
• Wound care: the entry site is small — keep it clean and dry as instructed, and watch for any signs of redness, swelling, or discharge that could indicate infection
• Blood-thinning medications: if these were paused before the procedure, your doctor will decide when it is safe to restart them
• Follow-up imaging: a CT scan or X-ray is often taken shortly after the procedure to confirm cement placement; further follow-up appointments will be scheduled to monitor your spine
• Bone health treatment: if osteoporosis caused the fracture, your doctor will usually recommend treatment to strengthen bones and prevent future fractures — this is an important part of long-term care
• Physiotherapy: in many cases, a guided exercise programme is recommended after recovery to strengthen the muscles supporting the spine and improve posture
• Lifestyle: maintaining a balanced diet with adequate calcium and vitamin D, avoiding smoking, and reducing fall risks at home are typically encouraged to protect the spine going forward