Vertebroplasty
Minimally invasive bone cement injection to stabilize painful vertebral compression fractures
Vertebroplasty is a minimally invasive procedure in which medical-grade bone cement (PMMA — polymethylmethacrylate) is injected directly into a fractured vertebral body under fluoroscopic (X-ray) guidance to stabilize the fracture and relieve pain. It is most commonly performed for osteoporotic vertebral compression fractures — the most common fragility fracture in older adults — as well as for pathological fractures caused by spinal metastases. Unlike kyphoplasty, vertebroplasty does not use a balloon to create a cavity or attempt to restore vertebral height before cement injection. Most patients experience significant pain relief within 24–48 hours of the procedure.
Who Is a Candidate?
- Osteoporotic vertebral compression fracture with pain not controlled after 4–6 weeks of conservative care (bracing, analgesics, activity restriction)
- Pathological vertebral fracture from metastatic bone disease with significant mechanical pain
- Progressive vertebral body collapse on serial imaging despite conservative management
- Fracture confirmed to be acute or subacute on MRI (bone marrow edema present — older fractures respond less predictably)
- Patient unable to tolerate prolonged immobilization or bed rest due to pain
What to Expect
1Before Surgery
MRI of the spine is obtained before the procedure to confirm the fracture is acute or subacute (bone marrow edema on STIR sequences) and to rule out contraindications including spinal cord compression, significant canal compromise, or infection. Blood work and coagulation studies are reviewed. The procedure is performed as an outpatient or single overnight stay.
2The Procedure
The patient is positioned prone (face down). Under local anesthesia and IV sedation, the interventional spine surgeon uses fluoroscopic guidance to place an 11-gauge trocar through the skin and into the fractured vertebral body via a transpedicular or extrapedicular approach. Bone cement (PMMA) is mixed to a paste consistency and injected slowly under continuous fluoroscopic monitoring to confirm cement flow and detect any leakage. Typically 1–3cc of cement is injected per vertebral level. The trocar is removed and the small skin puncture is covered with a bandage. The procedure takes 45–90 minutes, longer for multilevel fractures.
3Recovery
Patients are observed for 1–2 hours and typically discharged the same day or the following morning. Most patients experience significant pain relief within 24–48 hours. Light activity resumes within a few days. No heavy lifting or strenuous activity for 4–6 weeks. Osteoporosis treatment (bisphosphonates, denosumab, teriparatide) must be initiated or optimized to reduce the risk of adjacent level fractures — the underlying bone disease requires treatment regardless of the procedure.
Typical Outcomes
75–90% of patients report significant pain reduction (≥50% improvement on pain scales) within 24–48 hours. Functional improvement and reduced analgesic use are typically sustained at 6–12 months in responders. Vertebroplasty does not restore vertebral height (unlike kyphoplasty). Clinical benefit over sham procedure remains debated in the literature based on two 2009 NEJM placebo-controlled trials, but observational registry data and clinical experience support benefit in carefully selected patients with acute fractures confirmed on MRI.
Risks & Considerations
- Cement leakage: detected in 30–70% of cases on imaging, but clinically significant complications occur in <5% of patients; leakage patterns include disc space (most common), paravertebral soft tissue, and venous system
- Pulmonary cement embolism from venous leakage: rare but potentially serious; incidence <1%
- Adjacent level vertebral fracture: occurs in 20–25% of patients at 1 year — this reflects the underlying osteoporosis rather than the vertebroplasty itself (rates are similar in non-operated patients with equivalent fractures)
- Infection at the treated level: very rare, <0.1%
- Neurological injury from canal compromise by cement leakage: rare with careful technique
- Contrast or cement allergy
- Note: Two NEJM placebo-controlled trials (2009) showed similar improvement in the vertebroplasty and sham procedure groups at short-term follow-up; however, subsequent registry studies and real-world evidence support clinically meaningful benefit in appropriately selected patients with confirmed acute fractures
Frequently Asked Questions
Is vertebroplasty painful?
The procedure is performed under local anesthesia and IV sedation, so patients do not feel the needle or cement injection. Some soreness at the puncture site is common for a few days after the procedure. Most patients experience a significant reduction in back pain — often described as dramatic — within 24–48 hours, which is the opposite of the soreness from the procedure itself.
How long does vertebroplasty last?
The cement stabilization is permanent — PMMA does not degrade over time. Pain relief in good responders is typically durable at 1–2 year follow-up. The main ongoing risk is new fracture at an adjacent vertebral level, which is related to the underlying osteoporosis rather than the vertebroplasty. This is why osteoporosis treatment is essential after the procedure.
What is the difference between vertebroplasty and kyphoplasty?
Both procedures inject bone cement into a fractured vertebra. The key difference is that kyphoplasty uses a balloon inflated inside the vertebra before cement injection to create a cavity and attempt to restore vertebral height. This allows cement injection at lower pressure (reducing leakage risk) and may restore some lost vertebral height. Vertebroplasty injects cement directly at higher pressure without height restoration. Both provide equivalent pain relief in clinical trials. Kyphoplasty is slightly more involved and typically costs more.
Is vertebroplasty covered by insurance?
Medicare and most major insurers cover vertebroplasty for osteoporotic vertebral compression fractures that meet clinical criteria: acute or subacute fracture confirmed on MRI, pain refractory to conservative care, and no significant spinal canal compromise. Coverage criteria vary by payer and may require documentation of conservative treatment failure. Vertebroplasty for metastatic pathological fractures is generally covered with appropriate oncologic documentation.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed April 2026. CPT: 22521.