Vertebra (spine) fractures, especially in conditions that reduce bone density such as osteoporosis, can occur even with falls or minor traumas in daily life. These types of fractures are known as “spinal compression fractures.” When the integrity of the spine—which supports the human body and protects the internal organs—is compromised, both restricted movement and pain can occur. Kyphoplasty and vertebroplasty are two minimally invasive methods widely used today to treat these fractures and restore the integrity of the vertebrae.
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Exactly Are Kyphoplasty and Vertebroplasty?
Vertebroplasty:
Vertebroplasty is a treatment method in which a special bone cement (polymethylmethacrylate – PMMA) is injected into the fractured or collapsed vertebral body (similar to filling cracks in a building with a repair material). Amaç omurdaki kırığı sabitlemek ve hastanın ağrısını hafifletmektir. This procedure stabilizes the spinal structure and prevents further collapse of the fractured area.
Kyphoplasty:
Kyphoplasty can be described as a “step beyond” vertebroplasty. During kyphoplasty, a special balloon is first inserted into the vertebra, and this balloon is then inflated to try to restore some of the lost height of the fractured or collapsed area. After the balloon is withdrawn, the resulting space is filled with bone cement. This not only prevents further collapse of the vertebra but also partially corrects its original height, aiming to reduce postural abnormalities such as a hunchback.
The common goal of both methods is to alleviate pain, restore spinal stability, and enable the patient to return more comfortably to daily life. In this regard, they can both be summarized as “minimally invasive spinal repair techniques that allow for rapid recovery.”
In Which Situations Are These Methods Preferred?
Osteoporotic Fractures:
Osteoporosis is a disease that causes a decrease in bone density and makes bones porous. Particularly with advancing age, bones become more fragile. Thus, even minor falls can lead to vertebral compression fractures. Kyphoplasty and vertebroplasty are frequently preferred to quickly alleviate painful spinal fractures caused by osteoporosis.
Traumatic Spinal Fractures:
Compression fractures in the vertebrae can occur due to falls from a height, traffic accidents, or similar impacts. If there is no severe deformity of the spinal structure or nerve tissue compression, these minimally invasive methods come into consideration.
Tumor-Related Fractures (Malignancy or Metastasis):
In some types of cancer, tumors can spread to the spine and weaken the bones. In such cases, these methods may be used to control pain and support the spine.
Vertebral Hemangioma and Kümmell Disease (Vertebral Osteonecrosis):
In cases of benign vascular malformations (hemangiomas) or when collapse develops due to compromised blood supply in the vertebra (Kümmell disease), kyphoplasty or vertebroplasty may also be options.
The basic criterion is the presence of severe spinal pain that cannot be alleviated by conservative methods (such as medication, muscle relaxants, rest, physical therapy, braces, etc.) and a need to stabilize the fracture.
What Are the Differences Between Kyphoplasty and Vertebroplasty?
We can compare these two methods to repairing cracks and column problems in a building.
Vertebroplasty is similar to stabilizing the columns of a building by filling the existing crack with a repair material. No “height or shape correction” is intended.
Kyphoplasty, on the other hand, is akin to first using a balloon to adjust the shape of the column and then filling the resulting space with a repair material, in order to correct the collapse slightly and restore height. In this way, both the column (i.e., the vertebra) is supported and a portion of the lost height of the collapsed part is regained.
Kyphoplasty is generally preferred in situations where vertebral height is maintained or when there have been recent collapses. Because if the collapsed part of the vertebral body can be “lifted” with the help of a balloon, the patient’s spinal curvature (kyphosis) may be partially corrected. However, this height correction may not always be permanent or significant. In some patients, part of the height gain may be lost over time.
Vertebroplasty, on the other hand, does not include an additional step such as balloon inflation. Therefore, the application time and technical steps may be shorter. However, it does not aim to correct the vertical dimension of the vertebra; its primary goal is to alleviate pain and provide stabilization.
Which Method Is More Suitable for Which Patient?
Duration and Degree of the Fracture:
- In newly developed fractures (acute or subacute), since the bone is still “more responsive to intervention,” it may be possible to regain height with kyphoplasty.
- In long-standing (chronic) fractures, when the vertebra has hardened and fixed its position, even a balloon may have difficulty correcting the height. In such cases, vertebroplasty can also be an effective option.
Complaint of Kyphosis:
- If the fracture has caused a noticeable increase in kyphosis (forward bending posture, hunching of the back) and the patient is seriously troubled by this, kyphoplasty may be recommended. This is because this method can partially correct the spinal curvature.
Bone Condition (Level of Osteoporosis):
- In cases of severe osteoporosis, different fractures may occur during balloon inflation. However, this risk can be minimized in experienced hands and with proper patient selection.
General Health Status:
- It is also important whether the patient can undergo general anesthesia or remain sufficiently still during the procedure.
- Both procedures are generally performed under light sedation and local anesthesia. However, if the person has other illnesses or is of advanced age, planning is done accordingly.
Which method is more appropriate is decided by an expert physician who evaluates the characteristics of the spinal fracture and the patient’s overall health. Ideally, the advantages and disadvantages of both methods are explained to the patient to reach a joint decision.
How Are These Procedures Performed?
Vertebroplasty Process
Preparation and Anesthesia: The patient is usually administered light sedation (intravenous sedative medication) and local anesthesia to the fracture area. The patient is not fully put to sleep during the procedure, but lies comfortably on their back or stomach.
Needle Insertion: Under fluoroscopic (real-time X-ray) guidance, a special needle is inserted into the level of the spine where the fracture is located. This needle can be thought of as a drill bit directly addressing the crack in a building’s wall.
Cement Injection: A type of “bone cement” called polymethylmethacrylate (PMMA), which has a toothpaste-like consistency, is injected through the needle into the fractured area of the vertebra. This material hardens quickly, supporting the vertebra from within.
Short Observation and Discharge: After the injection, the patient is observed for a period. If there are no adverse events, the patient is usually discharged on the same day.
Kyphoplasty Process
Preparation and Anesthesia: Similar to vertebroplasty, light sedation and local anesthesia are administered. The patient again assumes a face-down position or is positioned on a specially designed table.
Balloon Application: A special balloon (balloon trocar) is inserted into the vertebra under fluoroscopic guidance and advanced to the appropriate level. This balloon is slowly inflated to attempt to correct the collapsed portion of the vertebral body.
Cement Filling: After the balloon is deflated and removed, the resulting space is filled with the prepared bone cement. The aim is to restore the vertebra to its original height and stabilize it.
Short Observation and Discharge: Depending on the number of fractures treated, the procedure duration may be longer; however, like vertebroplasty, kyphoplasty often allows for discharge on the same or the next day.
Both procedures usually take less than 1 hour. The duration may vary depending on the number of vertebrae involved, the patient’s condition, and the choice of anesthesia.
How Effective Are They in Pain Relief?
Both kyphoplasty and vertebroplasty are considered highly successful in relieving pain associated with spinal compression fractures. Pain relief is often observed shortly after the procedure (within a few hours or days). To illustrate:
Vertebroplasty: The fractured area is filled with cement, stabilizing the cracked columns much like repairing a building. The stabilization prevents micro-movements that cause pain, leading to rapid pain reduction.
Kyphoplasty: In this procedure, the same stabilization is achieved, but with the additional step of attempting to correct the column’s curvature. As a result, improvements are also seen in pain caused by spinal curvature in the back and lumbar region.
The pain-reducing effect continues in the long term as well. However, if there is an underlying progressive disease such as osteoporosis, there is a risk of fractures in other vertebrae. Therefore, a comprehensive approach involving bone-strengthening medications, proper nutrition, exercise, and regular medical check-ups is always important.
How Does the Recovery Process Progress?
Discharge from Hospital and the First Days:
- Many patients return home on the same day as the procedure.
- Pain generally decreases rapidly after the procedure. There may be a slight ache or pressure sensation in the treated area, but it is usually not severe enough to require strong painkillers.
- Bed rest is recommended during the first 24-48 hours, but complete immobility is not advised. Regular, gentle movements support recovery.
The First Week:
- Patients can generally begin to gradually return to their daily routines.
- It is beneficial to avoid movements that strain the spine, such as heavy lifting or bending.
- Some patients, especially after kyphoplasty, may be advised to wear a light brace.
After 1 Month:
- If deemed appropriate by the doctor, low-intensity walking or light exercises may be started.
- Physical therapy can be useful to strengthen the muscles and prevent future fractures.
- In patients with osteoporosis, medication, calcium and vitamin D supplements, and exercises that preserve bone density are important.
Long-Term Follow-Up:
- Regular follow-up imaging such as X-rays or MRIs are performed to monitor the condition of the cement-filled vertebra and overall spinal health.
- If the patient experiences severe back or lumbar pain again, it should be investigated whether a new vertebral fracture has occurred.
What Are the Complications and Possible Side Effects?
Like any medical procedure, both kyphoplasty and vertebroplasty carry certain risks. These risks can be minimized with an experienced team and proper patient selection.
Cement Leakage:
Leakage of the bone cement outside the vertebra is the most frequently discussed complication. However, most leakages remain around the vertebra without causing clinical issues. Rarely, if the cement leaks into a nerve root, the spinal canal, or blood vessels, it may cause pain, nerve damage, or embolism.
Infection:
Although minimally invasive, the risk of infection is not zero, as with any surgical procedure. If signs such as redness, discharge, or fever appear at the incision site after the procedure, prompt intervention may be required.
Bleeding or Hematoma:
The spinal region is rich in blood vessels. Especially when multiple vertebrae are treated, minor bleeding or hematoma formation may occur at the needle insertion sites.
Nerve Injury:
Since the procedure is performed under fluoroscopy, the risk is minimal; however, the nerves around the spine may be injured due to incorrect needle placement or cement leakage. This is very rare in procedures performed by experienced teams.
Adjacent Vertebral Fractures:
Some studies suggest that the hardening of the treated vertebrae through kyphoplasty or vertebroplasty may increase the risk of fractures in the adjacent upper or lower vertebrae. However, this issue has not been conclusively established in the medical literature, and the underlying osteoporosis itself can also cause new fractures.
Although the incidence of these complications is low, patients should be informed before the procedure and monitored closely for any signs afterward.
What Are the Advantages?
Rapid Pain Control:
The greatest advantage of these methods is that they quickly and often dramatically reduce spinal pain. Patients can usually get up and return to their daily activities shortly after the procedure.
Short Hospital Stay:
Since these procedures do not require major surgery and are generally performed under local anesthesia and sedation, patients can often be discharged on the same day.
Spinal Stabilization:
Especially in patients with low bone density, these procedures prevent further collapse of the fractured area. In some cases, kyphoplasty also partially restores the vertebral height.
Improvement in Quality of Life:
Patients experience increased mobility, and the reduced need for pain medications has a positive effect on overall quality of life.
Suitability for Different Patient Groups:
They offer an option for elderly patients with osteoporosis, those with tumor-related fractures, and even some traumatic fractures. However, as every patient and fracture is different, a detailed evaluation is essential.
Who Should Perform These Procedures and Where?
Kyphoplasty and vertebroplasty are performed by specialists with advanced training in spinal surgery and interventional radiology. Ideally, these procedures should be carried out in fully equipped hospitals or specialized centers. The availability of special equipment such as fluoroscopy (real-time X-ray imaging) is essential. Additionally, having anesthesia and emergency intervention capabilities is important to manage any potential complications promptly.
What Should Be Considered Before and After the Procedure?
Before the Procedure:
- The use of blood thinners, diabetes, heart disease, and other accompanying conditions should be communicated to the doctor.
- If necessary, blood thinners may be stopped or their dosages adjusted for a period.
- The duration of fasting before the procedure is determined by the doctor or anesthesia specialist.
After the Procedure:
- For the first few days, strenuous physical activities should be avoided, but complete immobility is not advised.
- Weight control and proper nutrition are important to prevent the progression of osteoporosis.
- The exercises, physical therapy programs, and regular follow-up appointments recommended by the doctor should not be neglected.
Taking Care of Bone Health:
- For the treatment or prevention of osteoporosis, proper nutrition and supplements, especially calcium and vitamin D, are essential.
- Regular exposure to sunlight supports the synthesis of vitamin D in the bones.
- Smoking and excessive alcohol consumption adversely affect bone health and should be strictly limited.
How Can I Protect My Spine in the Long Term?
Some important points for protecting the spine after the procedure are as follows:
Exercise and Physical Therapy:
Low-intensity activities such as walking, swimming, Pilates, or yoga strengthen the back and lumbar muscles, thereby supporting the spine. These activities are effective in preventing new fractures.
Balanced Nutrition:
Consuming plenty of vegetables, fruits, protein sources, and dairy products to ensure sufficient calcium intake, as well as regular monitoring of vitamin D levels, is necessary for bone integrity.
Posture Training:
Maintaining a constant hunched posture increases the load on the spine. Developing proper habits for sitting, standing, and bending correctly can help prevent the progression of kyphosis.
Weight Control:
Excess weight increases the load on the spine, raising the risk of new fractures. Therefore, maintaining an ideal weight is advantageous for spinal health.
Regular Doctor Visits:
Spinal condition can be closely monitored with periodic bone density tests, X-rays, or MRIs. Early detection of new fractures facilitates easier treatment.
Frequently Asked Questions
Generally, the procedure lasts between 30 minutes and 1 hour. Since it is performed under local anesthesia and light sedation, the patient does not feel significant pain or discomfort. There may be a slight sensation of pressure during the procedure, but it is generally tolerable.
Most patients experience immediate pain relief. The time required for complete recovery and return to previous activity levels depends on the patient’s overall health and the severity of the fracture. Generally, patients can resume most daily activities within 1-2 weeks.
Yes, if a similar fracture occurs in a different vertebra and it causes pain, kyphoplasty or vertebroplasty can be applied again after the necessary evaluations.
They may not be suitable for all spinal fractures. In more complex cases such as spinal canal compression, severe nerve damage, or multi-fragmented fractures, different surgical methods may be required. Expert evaluation is essential.
Generally, yes. However, patients with osteoporosis should not neglect bone-strengthening precautions and should avoid excessively strenuous activities. With a conscientious lifestyle, a comfortable spinal structure can be maintained for many years.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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