Kyphoplasty and Vertebroplasty

September 3, 2024

This page was reviewed under our medical and editorial policy by Jonathan Kessler, M.D., associate clinical professor, division of interventional radiology, Department of Diagnostic Radiology, City of Hope^® Cancer Center Duarte

Kyphoplasty and vertebroplasty are interventional radiology procedures that may be recommended to relieve pain in patients with compression fractures in the spine.

The spine is made up of small rectangular vertebrae that are stacked on top of one another. Compression fractures in the spine may happen when vertebrae become weak. Diseases — such as osteoporosis, metastatic cancer (cancer that spreads beyond the original site) or myeloma (a type of type of blood cancer) — sometimes cause the bones in the spine to weaken, break, shift or lose their shape. These changes may lead to pain from bones rubbing against one another or pressing on the spinal cord.

Most metastatic bone disease in cancer patients does not require surgery. Less invasive treatments such as kyphoplasty or vertebroplasty may be recommended as an alternative when cancer impacts the spine. These treatments rely on image-guided therapy, known as fluoroscopy, which allows the doctor to access an area of the spine with a needle.

An interventional radiologist — a doctor who specializes in the use of imaging during medical procedures — and other doctors who specialize in the spine may perform kyphoplasty and vertebroplasty.

What Is Kyphoplasty?

Kyphoplasty is a procedure that treats pain from compression fractures in the spine.

Kyphoplasty, which is also known as balloon kyphoplasty, realigns and strengthens damaged vertebra with surgical cement.

During the procedure, an interventional radiologist uses a hollow needle to temporarily insert a balloon into the damaged bone. When the balloon is inflated, it creates a space that restores the height of the vertebrae. The balloon is then removed. A special cement is injected into the new cavity to make it stronger and prevent it from collapsing again.

What Is Vertebroplasty?

Vertebroplasty is also a procedure that treats pain from compression fractures in the spine.

While vertebroplasty also uses bone cement to strengthen damaged vertebrae, no balloon is used with this method.

During the procedure, a hollow needle is inserted into the damaged bone and medical-grade cement is injected. With vertebroplasty, pain relief comes from the improved integrity of the bone with increased strength and density. This also helps to relieve any stress put on nerve endings where the bone was weak.

How Are They Performed?

An interventional radiologist may perform either of these minimally invasive procedures in a hospital or outpatient clinic. The patient will typically receive anesthesia for pain relief.

Kyphoplasty and vertebroplasty rely on real-time X-ray imaging for the doctor to guide the needle into the appropriate location for the bone cement.

The patient lies face down on a table in a room with an X-ray machine above the table.

One or two X-ray tubes and a video monitor in the room allow the doctor to observe and guide the procedure.

The doctor cleans the area of the back and applies numbing medication.

Using X-ray imaging, the doctor passes a small needle through the skin into the damaged bone. With kyphoplasty, a balloon is passed through the needle to the damaged bone area and is inflated to create more space between vertebrae for the cement. The balloon is removed and the cement is injected into the space. With vertebroplasty, no balloon is used. The cement is injected through the needle into the weak bone to help strengthen it.

Either procedure typically lasts about an hour from start to finish. If more than one vertebra is treated, the surgery may take longer.

Kyphoplasty and Vertebroplasty Recovery

Recovery time following either procedure is relatively quick. Most patients return home the day of the surgery, but some will stay overnight in the hospital.

Immediately following surgery:

• Patients are moved to a recovery area for a few hours where vital signs (such as blood pressure and oxygen level) are monitored.
• If general anesthesia is used, a patient is monitored for any negative effects as they wake up from the medication.
• Many patients experience relief from severe pain immediately following the surgery.
• Patients need to have someone drive them home.

Recovering at home:

• The surgical site will feel sore for a few days. Using ice packs for 15 minutes on, then 30 minutes off will help with this discomfort. Ice packs should never go directly on the skin. Always use a barrier, such as a washcloth, between the skin and ice pack.
• The surgical team may recommend pain medication, such as ibuprofen or acetaminophen, for additional pain relief.
• Patients may shower with the bandage in place for the first few days after the surgery.
• Most people gradually return to their regular activities, starting about 24 hours after surgery. Strenuous activities, heavy lifting, and excessive bending or twisting should be avoided for about six weeks.

How Long Does the Cement Last?

The injected cement remains in the spine for the rest of the patient’s life. The cement, however, does not adhere or stick to the bone, and it may loosen over time. If the diseased bone worsens over time, additional fractures may occur at the same or other levels. Repeat treatment is sometimes used to treat this condition.

Side Effects

As with all surgeries and procedures, some side effects are possible. Risks of these procedures are quite rare and usually manageable with medical treatment.

Side effects linked to kyphoplasty and vertebroplasty may include:

• Infection, which may require antibiotics to treat
• Bleeding
• Increased back pain and neurological symptoms, such as tingling or numbness
• Extremely rare instances of nerve injury or paralysis
• Leakage of bone cement into surrounding tissue, which may cause increased pain and lead to further surgery or treatments to remove the cement
• Rare instances of cement leakage into veins leading to vessel blockage
• Reactions to the medications used in surgery, including allergy, breathing issues or heart problems from the anesthesia
• Additional compression fractures, which may cause recurring pain after the surgery