Vertebroplasty and kyphoplasty are both minimally invasive procedures that treat spinal compression fractures by injecting bone cement into a damaged vertebra. The key difference is one extra step: kyphoplasty uses an inflatable balloon to create a cavity inside the fractured bone before the cement goes in, while vertebroplasty injects cement directly. That single distinction affects height restoration, cement leakage rates, and which procedure your doctor is likely to recommend.
Both procedures target the same problem and produce similar pain relief, with roughly 87% to 92% of patients reporting at least some improvement. But the details of how they work, their safety profiles, and the situations that favor one over the other are worth understanding if you’re facing this decision.
How Each Procedure Works
In vertebroplasty, a doctor inserts a hollow needle through a small incision in your back, guided by real-time imaging, directly into the fractured vertebra. Bone cement is then injected through the needle into the collapsed bone. The cement hardens within minutes, stabilizing the fracture and reducing pain. The entire concept is straightforward: fill the break, lock it in place.
Kyphoplasty adds a step before the cement. After the needle reaches the vertebra, a small balloon (called a tamp) is threaded through and inflated inside the fractured bone, reaching pressures up to 220 psi. This inflation compresses the broken bone fragments outward and creates a hollow space. The balloon is then deflated and removed, and cement is injected into that pre-formed cavity. The goal of the balloon step is twofold: push the collapsed vertebra back toward its original height and create a contained space so the cement flows more predictably.
Height Restoration and Spinal Alignment
When a vertebra collapses from a compression fracture, it loses height, often becoming wedge-shaped. This can contribute to a hunched posture (kyphosis), especially when multiple vertebrae are affected. One of kyphoplasty’s main selling points is its ability to restore some of that lost height.
In practice, the height gains are modest. Kyphoplasty proponents have reported restoration of 3 to 5 millimeters of vertebral height, with kyphotic angle improvements of 3 to 14 degrees. However, a study published in the American Journal of Neuroradiology found the two procedures closer than expected: kyphoplasty restored about 1.5 mm of height on average, while vertebroplasty restored 1.4 mm. Earlier cadaveric research showed kyphoplasty recovering 93% of original height compared to 82% for vertebroplasty. The real-world difference exists but may be smaller than the theory suggests, and results vary considerably depending on the fracture’s age and severity.
Cement Leakage Risk
The most significant safety difference between the two procedures is how often bone cement leaks outside the vertebra. Cement that escapes can migrate into surrounding tissues, the spinal canal, or nearby veins, occasionally causing nerve compression or, rarely, reaching the lungs.
A meta-analysis of 22 studies covering nearly 3,000 patients found cement leakage rates of 54.7% for vertebroplasty compared to 18.4% for kyphoplasty. That’s a roughly threefold difference. Most leaks are small and cause no symptoms, but the gap is large enough that kyphoplasty has become the preferred procedure for osteoporotic compression fractures in many practices. The balloon step is the reason: by creating a contained cavity first, cement flows into a defined space rather than seeping through cracks in fractured bone.
Several factors increase leakage risk regardless of which procedure is used. Fractures with breaks in the outer shell of the vertebra (cortical disruption) carry more than five times the risk. Using cement that’s too thin or injecting too much volume also raises the odds. Your surgeon will evaluate these factors on imaging before recommending one approach over the other.
Pain Relief Comparison
When it comes to the outcome patients care about most, the two procedures perform similarly. A large systematic review covering 69 clinical studies found that 87% of vertebroplasty patients and 92% of kyphoplasty patients reported at least some pain relief. Pooled data from thousands of treated fractures showed comparable pain reduction, with vertebroplasty data extending up to five years and kyphoplasty data reaching two years of follow-up.
For patients with fractures related to cancer, specifically multiple myeloma or metastatic disease, a review of 56 patients found that 84% experienced marked or complete pain relief within about four and a half months. Kyphoplasty tends to be favored in myeloma-related fractures because it offers better height correction and lower cement leakage rates in bone that’s already compromised by disease.
Risk of New Fractures
A common concern is whether reinforcing one vertebra with cement puts extra stress on the vertebrae above and below, leading to new fractures. A network meta-analysis of 23 randomized controlled trials involving 2,838 patients found no significant increase in adjacent-level fracture risk for either procedure compared to letting compression fractures heal on their own. Over an average follow-up of about 21 months, both kyphoplasty and vertebroplasty showed statistically similar fracture rates to no intervention at all. The fear of a “domino effect” doesn’t appear to be supported by the current evidence.
Who Qualifies for Either Procedure
The eligibility criteria are the same for both. You’re typically considered a candidate if you have an active vertebral compression fracture that’s been confirmed on imaging, pain that corresponds to the fracture site, high pain intensity, and you haven’t improved with conservative treatment like pain medication, bracing, or rest.
Certain fracture patterns rule out both procedures. Burst fractures, where bone fragments have pushed backward toward the spinal cord, are an absolute contraindication. The same applies to fractures with significant damage to the back wall of the vertebra that could put nerves at risk, or cases where the vertebra has nearly completely collapsed (called vertebra plana), leaving too little bone to work with. Spinal instability or symptoms of nerve compression from the fracture also generally mean a different surgical approach is needed.
Kyphoplasty has one edge in eligibility: it has been shown to be safe and effective even in some cases with posterior wall defects that were previously considered off-limits. This gives surgeons slightly more flexibility when choosing kyphoplasty for complex fractures.
What Recovery Looks Like
Both procedures are outpatient for most patients. You go home the same day. The insertion site on your back may be sore for a few days, but the fracture-related pain often improves quickly, sometimes within hours. You’ll generally need to avoid heavy lifting for at least six weeks.
Kyphoplasty can be performed under local anesthesia, general anesthesia, or sedation. Local anesthesia is common because it’s faster and less expensive, though some patients find the procedure painful enough to require deeper sedation, particularly during the balloon inflation step. Vertebroplasty is also typically done under local anesthesia with sedation. The choice of anesthesia depends on the patient’s pain tolerance, the number of vertebrae being treated, and the surgeon’s preference.
Which Procedure Is Better
Neither procedure is categorically superior. They relieve pain equally well, and the risk of future fractures at adjacent levels is comparable. Kyphoplasty’s advantages are a meaningfully lower rate of cement leakage and modestly better height restoration. Vertebroplasty’s advantages are simplicity and, because it skips the balloon step, potentially lower cost and slightly shorter procedure time.
In practice, kyphoplasty has become the more commonly recommended option for osteoporotic compression fractures, largely because of its safety advantage with cement containment. For fractures related to cancers like multiple myeloma, kyphoplasty is also generally preferred. Vertebroplasty remains a reasonable choice for straightforward fractures where height loss is minimal and the risk of cement leakage is low based on imaging. Your surgeon’s recommendation will depend on the specific fracture pattern, how much collapse has occurred, and the integrity of the vertebra’s outer walls.