Percutaneous Vertebroplasty

What is percutaneous vertebroplasty?

  • Percutaneous vertebroplasty is a minimally invasive procedure for the treatment of painful spinal compression fractures often occurring in people with underlying osteoporosis.

What is osteoporosis?

  • Osteoporosis is a common bone disease resulting in weakening of bone tissue and loss of bone mineral density with age. This deterioration of bone increases its fragility and susceptibility to fractures. A 10% loss of bone mass in the vertebrae can double the risk of vertebral compression fractures.

Who is affected by osteoporosis?

  • Osteoporosis is estimated to affect 200 million women worldwide and 10 million people in the United States.

    Men are affected less often (5 women for every man affected) but experience the same consequences.

    Osteoporosis in the United States will increase fourfold over the next 50 years as our population ages.

    In 2005, there were over 500,000 osteoporotic vertebral compression fractures in the United States costing over $1 billion to treat.

Who is at risk for fractures due to osteoporosis?

  • Approximately half as many men have vertebral compression fractures when compared to women.

    1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men.

    The incidence of osteoporotic fracture is usually higher for whites than for other ethnic groups.

    Young patients can also have osteoporosis and are therefore at increased risk for fractures if they have predisposing risk factors such as long-term corticosteroid use or underlying conditions such as chronic kidney disease.

  • Risk Factors for osteoporosis:


    Being Female

    Family history of osteoporosis


    Causcasian or Asian descent

    Inactivity (confined to a bed)

    Chronic Kidney disease

    Rheumatoid arthritis

    Long-term corticosteroid use

    Vitamin D deficiency

    Too little calcium in diet

    Drinking too much alcohol

    Low body weight


    Hormone treatment for prostate/breast cancer

    Eating disorders (poor nutrition)

What is a vertebral compression fracture and why does it occur?

  • If bone is normal (no osteoporosis), an abnormally large force, such as a motor vehicle accident or fall from a height, is required to cause a vertebral compression fracture.

    However, in patients with abnormal bone (osteoporosis), even a minor force of impact can cause a fracture. Examples of minor force include twisting the back, lifting a heavy object, or driving over a pothole in the road.

    It is important to note that a compression fracture is usually a stable fracture and will not usually impose adverse affects on the spinal cord or nerve roots.


    Typically, compression fracture causes sudden, severe pain coinciding with the level of fracture.

Where do fractures due to osteoporosis occur?

  • Common sites for osteoporotic fracture include the extremities, hip and spine. Vertebral fractures are often called "compression fractures" because the vertebral body loses height when seen on x-ray studies.

Where do vertebral compression fractures occur?

  • Most vertebral compression fractures occur in the thoracic and lumbar spine.

Why are compression fractures painful?

  • The pain from fractured bone can be severe. Bones, including the spine, have nerve endings - just as skin and muscle do. Moving and twisting the body will cause the fractured bone fragments to move along the fracture plane(s), resulting in pain.

What happens to a compression fracture over time?

  • Over time, most compression fractures will heal. Conservative therapy, including bed rest and pain control, may suffice. This healing process may take several weeks to a few months.

    As the fracture heals, then the pain should diminish.

    The compression fracture may retain its new, shorter height but most fractures tend to compress further over time with or without additional episodes of pain.

    Some fractures will not heal properly despite conservative therapy. If so, the pain may be debilitating and significantly impede normal activities of daily living (dressing, walking, toileting etc.).

    Having a compression fracture at one spinal level increases the risk of future compression fractures at other adjacent levels.

What are the available treatment options for a compression fracture?

  • The most common treatment options for a compression fracture include conservative therapy and vertebroplasty.

    Spinal surgery is rarely necessary for a vertebral compression fracture. You may need surgery if a severe fracture results in neurologic injury, severe angulation, if the fracture fails to heal, if significant angulation persists despite bracing or if neurologic symptoms increase over time.

    Conservative therapy includes bed rest with pain control. The process of healing may take several weeks to months. The shortcomings of prolonged bed rest include deconditioning, further demineralization of bone, the risk of nosocomial infection in hospitalized patients, pulmonary embolus from deep vein thrombosis and narcotic dependence. As soon as the patient tolerates the pain of moving, they are encouraged to sit in a chair and mobilize with pain control.

    Vertebroplasty procedures may be performed for painful compression fracture.

What should I expect when I have a vertebroplasty procedure?

  • The procedure involves guiding the tip a needle (similar in caliber to a ball point pen refill), under x-ray guidance, through the skin following along a safe path to the fracture. Bone cement (polymethylmethacrylate, similar to cement used in orthopedic procedures) is then injected through the needle to stabilize the fracture. At the end of the procedure, the needle is removed and a Band-Aid is applied to the puncture site on the skin.

    Vertbroplasty is commonly performed under local anesthesia with mild intravenous sedation and pain control to ensure your comfort throughout the procedure.

    In the outpatient setting, you can usually go home on the same day of the procedure after 2-3 hours of monitoring, to ensure complete recovery from sedation.

Who is a candidate for vertebroplasty?

  • A patient presenting with acute, debilitating and/or sudden onset of back pain correlating with positive MRI findings at the same level of the clinical exam is a good candidate for vertebroplasty.

    A patient who has undergone a trial of conservative therapy without improvement in debilitating pain, and with positive MRI correlation to the level of pain is a good candidate for vertebroplasty.

Does it really work/recent controversies?

  • There have been recent studies that claim vertebroplasty is no more useful than placebo in treating painful compression fractures. In short, even if placebo has a positive effect in shortening the length of hospital stay or helping people debilitated by pain get back into the work force, pursuing vertebroplasty is worthwhile. An indicated procedure for a properly selected patient has a good chance at successful pain relief.

What are the risks of vertebroplasty?

  • Radiologists have performed vertebroplasty procedures in the United States since 1993 and in France since 1983. The risks of vertebroplasty include infection, bleeding, direct damage to the spinal cord or nerve roots by the needle, rib fracture, leakage of cement outside of bone (into the spinal canal, neural foramen or into the lungs through veins) and non-healing of the interface between bone and cement. With careful attention, under x-ray guidance, the placement of the needle and the delivery of the cement can be well controlled. All of the above-mentioned risks lumped together should be no more than 1-2% in well-trained hands.

How much of my pain will go away?

  • If the procedure works, about 50-80% of the pain usually resolves immediately following the procedure. It may take up to 24 hours to fully appreciate the results of the procedure. With success, oral pain medications can be decreased until they are no longer needed.

How often is it successful?

  • This is the key question. More specifically, how do we define success? There is no doubt that success is related to how much pain is relieved after the procedure. If the patient selection is judicious and the likelihood of pain relief is well understood by doctor and patient, there is a good chance of gaining some degree of success.

Can vertebroplasty make the height of my bones normal again?

  • No. Vertebroplasty is performed to relieve pain. There is no percutaneous vertebral augmentation procedure that is proven, by significant clinical trial, to restore the normal height of a compression fracture.

Will vertebroplasty prevent future fractures?

  • No. In fact, studies show that there may be an increased risk for fractures in adjacent levels after vertebroplasty.

Can vertebroplasty help relieve pain or fracture related to bone tumors?

  • Yes. This procedure was originally developed to treat painful bone tumors in the spine. Some practitioners today may choose to first ablate the tumor with radiofrequency before delivering cement into the tumor / tumor fracture.

    Tumors that start in the spine and tumors that spread to the spine from another locations (metastatic disease) can be treated.

Future developments

  • Current research in this area involves the development of bone cement that will encourage the bone fracture to actively heal and promote new bone formation at the fracture.