Vertebroplasty

What is it?

Vertebroplasty is a procedure in which medical bone cement (polymethyl methacrylate) is injected through the skin into a vertebra that has collapsed because of a compression fracture. The cement hardens within minutes and supports the fractured bone from the inside. The aim is to reduce movement of the broken fragments, ease pain and stabilise the vertebra.

No surgical incision is needed; the procedure is carried out under fluoroscopy (live X-ray) or computed tomography (CT) guidance. In a related technique called kyphoplasty, a balloon is first used to create a space inside the vertebra before the cement is injected. Vertebroplasty does not treat osteoporosis (bone thinning) or a tumour itself; it targets the pain caused by the fracture.

When is it considered?

Most osteoporotic vertebral fractures heal over time with painkillers, a short period of rest, a brace if needed and physiotherapy, and the pain usually eases over a few weeks to a few months. Vertebroplasty is considered for selected people whose fracture is recent and not yet healed, and whose severe pain continues despite appropriate pain management. The UK's National Institute for Health and Care Excellence (NICE) recommends it only for people in this situation, and only when examination and imaging confirm that the pain comes from the level of the fracture.

It is important to be open about the evidence. A Cochrane review of trials in which some patients received a sham (simulated) procedure found that, for osteoporotic fractures, vertebroplasty gave no clinically important benefit over the sham procedure in routine practice. The decision is therefore made individually, taking into account the age of the fracture, the severity of the pain, the response to other treatments and overall health.

The situation is different when a tumour affects the spine. For people with spinal metastases or myeloma who have a painful fracture or a vertebra at risk of fracture, but no compression of the spinal cord, vertebroplasty may be an option to ease pain and support the vertebra, alongside radiotherapy and other cancer treatments. In this setting, the decision is made together with the oncology team and, where needed, spinal surgeons. For other options, see cancer pain.

How does it work?

Movement of the broken bone fragments is thought to be one of the main causes of pain in a compression fracture. Once the cement hardens inside the vertebra, it reduces this movement and provides internal support. The cement does not usually restore the height the vertebra has lost.

If pain eases, moving and walking may become easier. However, not all low back pain comes from a vertebral fracture; if the pain has another cause, vertebroplasty is not expected to help.

Before the procedure

An MRI scan is usually done to show whether the fracture is recent; if MRI is not possible, CT or a bone scan may be used. The examination checks whether your pain matches the level of the fracture. You will also be asked about any osteoporosis medicines and previous fractures. Blood tests are carried out, and you and your doctor will plan how to manage any blood thinners.

The aim of the procedure, its expected benefits, possible risks and the alternatives are explained before you give written consent. If sedation is planned, you will be asked to fast for a few hours beforehand.

What happens during the procedure?

You lie face down. The skin and the surface of the bone are numbed with local anaesthetic, with light sedation if needed. A wide-bore needle is guided through the skin into the body of the vertebra under imaging. If a tumour is suspected, a bone biopsy can be taken in the same session.

The cement is injected slowly and in a controlled way. Its spread is checked on imaging at every stage, and the injection is stopped if cement is seen spreading outside the vertebra. Depending on how many levels are treated, the procedure usually takes between half an hour and an hour.

After the procedure

You will lie on your back for a while as the cement sets, and you will be observed. Most people walk with support and go home the same day or the next day. The needle site may be tender for a few days. At your follow-up visit, the change in your pain is reviewed and, if needed, you are referred to the relevant specialist for osteoporosis treatment.

For the first few weeks, avoid heavy lifting and sudden twisting. Because vertebroplasty does not treat osteoporosis, it is important to continue treatment for bone health and to take steps to prevent falls. Seek help without delay if you develop new severe back pain, weakness or numbness in the legs, shortness of breath or chest pain.

When might you notice results?

In people who benefit, pain often eases within the first few days. In others, the pain does not improve enough, or part of it continues for other reasons.

Results vary from person to person, which is why expectations and alternatives are discussed before the procedure. To find out whether your fracture is suitable for this procedure, you can request a consultation.