Percutaneous vertebroplasty is used to treat painful vertebral compression fractures, most commonly caused by osteoporosis, spinal tumors, or cancer that has spread to the spine. The procedure involves injecting bone cement directly into a fractured vertebra to stabilize it, relieve pain, and prevent further collapse. It is a minimally invasive option reserved for patients whose pain has not improved with conservative treatments like pain medication, bracing, or rest.
Osteoporotic Compression Fractures
The most common reason for vertebroplasty is a compression fracture caused by osteoporosis. These fractures happen when weakened bones in the spine collapse under normal stress, sometimes from something as minor as sitting down abruptly. They cause intense back pain and can progressively worsen as increased pressure shifts to adjacent vertebrae.
Vertebroplasty provides rapid, lasting relief for these fractures. In one study, 66% of patients experienced significant pain relief within hours of the procedure, and another 29% had moderate improvement. A 10-year follow-up study found that pain relief and quality-of-life improvements remained significant a full decade after treatment. Pain scores dropped by more than half on average and stayed there. However, the underlying osteoporosis doesn’t go away: 53% of patients in that long-term study experienced new vertebral fractures over 10 years, and about 20% needed a repeat procedure.
Timing matters. The VAPOUR trial showed that vertebroplasty works best for acute fractures (less than six weeks old), delivering substantial pain relief compared to placebo that lasted at least six months. The VERTOS V trial also found benefits for chronic painful fractures persisting beyond three months, though the strongest case for the procedure is in recent, actively painful fractures confirmed by MRI.
Spinal Tumors and Multiple Myeloma
Vertebroplasty was originally developed in the late 1980s to treat vertebral hemangiomas (benign blood vessel tumors in the spine) and bone-destroying spinal tumors. It remains a key treatment for cancer-related compression fractures, particularly in patients with multiple myeloma, a blood cancer that frequently weakens vertebral bone.
The procedure is well suited for cancer patients because it can be performed under local anesthesia, provides rapid pain relief, and avoids the prolonged bed rest that comes with more invasive surgery. For patients who may already be weakened by chemotherapy or the disease itself, that distinction is significant. A Danish national clinical guideline recommends vertebroplasty specifically for painful compression fractures caused by cancer, including multiple myeloma. The cement stabilizes the fractured vertebra by stopping both the tiny internal movements that generate pain and the larger structural collapse that threatens spinal alignment.
High-Energy Fractures in Younger Patients
While most vertebral compression fractures occur in older adults with weakened bones, younger patients can sustain them through high-energy trauma like car accidents or falls from height. Vertebroplasty can be considered in these cases when the fracture causes persistent, severe pain that doesn’t respond to conservative care. It is also used when vertebrae have been weakened by infection, though active infection at the procedure site is a strict contraindication.
How the Procedure Works
Under imaging guidance (usually fluoroscopy, a type of real-time X-ray), a needle is inserted through the skin of the back and guided through the pedicle, a bony bridge on the vertebra, into the fractured bone. Medical-grade bone cement, most commonly polymethyl methacrylate (PMMA), is then injected into the vertebral body. The cement hardens within minutes, stabilizing the fracture internally.
A related procedure called kyphoplasty adds a step: a small balloon is inflated inside the vertebra before cement injection to restore some of the lost height. Both procedures deliver similar levels of pain relief. The choice between them often comes down to anatomy. Vertebroplasty uses a smaller needle, making it a better fit when the pedicles (the bony entry points) are narrow. Kyphoplasty tends to be chosen for more severely compressed fractures where height restoration is a priority.
Most patients go home the same day. The needle insertion site may be sore for a few days, and heavy lifting should be avoided for at least six weeks.
When Vertebroplasty Is Not Appropriate
Vertebroplasty is not a first-line treatment. Major medical societies agree it should only be considered after conservative measures have failed and the patient still has high pain levels that correlate with the fracture site on imaging. It is not used preventively in osteoporotic patients who haven’t fractured, and it’s not appropriate for fractures that are already healing well on their own.
The North American Spine Society’s most recent appropriate use criteria rated cement augmentation as “rarely appropriate” in 60% of clinical scenarios evaluated. It was rated appropriate with agreement in only 5% of scenarios, and those always involved high pain scores, acute fracture timing, and a simple fracture pattern. This reflects a conservative stance: the procedure works, but only for the right patient at the right time.
Absolute contraindications include uncontrollable bleeding disorders, active infection (local or systemic), allergy to bone cement, and asymptomatic fractures. Relative contraindications include fractures where the back wall of the vertebra is broken (risking cement leakage into the spinal canal) and severely collapsed vertebrae that have lost more than two-thirds of their original height.
Risks and Cement Leakage
The overall complication rate for vertebroplasty is low, but cement leakage is more common than many patients realize. When examined with CT scans after the procedure, leakage rates range from 11% to as high as 81%, depending on how carefully it’s measured. The vast majority of these leaks are small and cause no symptoms. Cement can seep into surrounding soft tissue, into the disc space between vertebrae, or along blood vessels near the spine.
Symptomatic leaks are rare but serious. In one study of 29 treated vertebrae, two cases required reoperation, both involving cement that leaked toward the spinal canal. The risk is higher when the back wall of the vertebra is compromised, which is why that situation is flagged as a relative contraindication before the procedure.