Vertebroplasty and Kyphoplasty¶

Overview¶

Vertebroplasty and kyphoplasty are minimally invasive percutaneous procedures for treatment of painful vertebral compression fractures. Both involve injection of polymethylmethacrylate (PMMA) bone cement into the fractured vertebral body through a transpedicular approach.

Difference Between the Two¶

Vertebroplasty — Direct injection of cement into the fracture without prior cavity creation
Kyphoplasty — A balloon is first inflated within the vertebral body to create a cavity and restore height, then cement is injected into the cavity. Theoretically reduces cement leakage risk and restores some vertebral height.

Normal Post-Procedure Appearance¶

Radiography/CT¶

PMMA cement is hyperdense (bright white) within the vertebral body
Cement should be contained within the vertebral body margins
Some restoration of vertebral height (more with kyphoplasty)

MRI¶

PMMA demonstrates signal void on both T1 and T2
Surrounding marrow edema may persist for weeks

Complications¶

Cement leakage — Most common complication. Cement can extravasate into the disc space, epidural veins, paravertebral veins, epidural space, or neural foramina.
Pulmonary cement embolism — Cement enters the venous system and embolizes to the lungs. Usually asymptomatic but can be fatal.
Adjacent vertebral fracture — Altered biomechanics may increase fracture risk at adjacent levels
Infection — Rare

Clinical Pearl

Cement leakage into the epidural space or neural foramina can cause cord compression or radiculopathy and may require surgical decompression. Always evaluate the epidural space on post-procedure CT. Cement in the basivertebral venous plexus or epidural veins is common and usually asymptomatic, but large-volume venous leakage raises the risk of pulmonary embolism.

Key Points¶

Vertebroplasty: direct cement injection; Kyphoplasty: balloon + cement
Cement leakage is the most common complication
Evaluate for epidural, venous, and disc space leakage on post-procedure CT
Pulmonary cement embolism is a rare but serious complication
Adjacent-level fracture is a recognized long-term complication

References¶

Gaillard F, et al. Vertebroplasty and kyphoplasty. Radiopaedia.org. Available from: https://radiopaedia.org/articles/vertebroplasty-and-kyphoplasty
Margetis K, Patel A, Petrone B, Carter KR. Percutaneous Vertebroplasty and Kyphoplasty. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525963/
Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408-1416. PMID: 27544377.
Klazen CAH, Lohle PNM, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085-1092. PMID: 20701962.
Firanescu CE, de Vries J, Lodder P, Venmans A, Schoemaker MC, Smeets AJ, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018;361:k1551. PMID: 29743284.
Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging; Khan MA, Jennings JW, Baker JC, et al. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol. 2023;20(5S):S102-S124. PMID: 37236738.