Vertebroplasty and Kyphoplasty
Vertebroplasty and kyphoplasty are two minimally invasive surgical techniques that offer rapid and effective pain relief for patients with vertebral fractures.
They are now established options in spinal surgery, with high success rates and short recovery times.
What are vertebroplasty and kyphoplasty?
Both procedures are based on the injection of special bone cement into the fractured vertebra, with the aim of stabilising it and relieving pain. They are performed under fluoroscopic (X‑ray) guidance, through a small skin incision, without the need for open surgery.
The key difference is that kyphoplasty includes an additional step before the cement injection, which allows restoration of vertebral height and correction of the deformity.
How is vertebroplasty performed?
Vertebroplasty is usually carried out under general anaesthesia and lasts approximately 30 to 60 minutes.
The patient is positioned prone and a small incision is made in the back.
A hollow needle is then advanced under continuous fluoroscopic guidance through the pedicle into the body of the fractured vertebra.
The special acrylic bone cement is injected, which hardens within a few minutes, stabilising the vertebra and reducing pain.
How is kyphoplasty performed?
Kyphoplasty follows the same initial steps as vertebroplasty, with one crucial additional stage.
Before the cement is injected, a special balloon is introduced into the fractured vertebra and gently inflated to create a cavity and partially restore the lost vertebral height. The balloon is then removed and the cavity that has been created is filled with bone cement.
This extra step offers two important advantages: it partially restores vertebral height and reduces the risk of cement leakage outside the vertebra, because the cement is injected into a pre‑formed cavity.
What is the difference between vertebroplasty and kyphoplasty?
The choice between the two techniques depends mainly on the type, extent and age of the fracture, and on whether restoration of vertebral height is required.
Kyphoplasty is preferred for relatively recent fractures with up to 70–80% loss of height, where height restoration is still feasible. It is also indicated for fractures at risk of further collapse, since the balloon creates a controlled cavity and reduces the risk of cement leakage.
Vertebroplasty is chosen in cases of complete vertebral collapse, where height restoration is no longer possible, and in situations where a simpler and faster procedure is required.
In unstable fractures or fractures with neurological deficits, neither technique is appropriate; in these cases, open decompression and stabilisation surgery is necessary.
When are these procedures indicated?
Both techniques are indicated in specific groups of patients and clinical situations.
The main indications include osteoporotic vertebral fractures with severe pain that does not respond to conservative treatment, pathological fractures due to metastatic disease or primary spinal tumours, elderly or frail patients with reduced healing capacity, and patients who cannot tolerate prolonged bed rest or strong analgesic regimens.
The decision is always based on imaging findings, clinical presentation and the individual needs of each patient.
Recovery and outcomes
Recovery after vertebroplasty or kyphoplasty is usually rapid. Most patients mobilise on the same or the following day and return home within 24 hours. Pain improvement is often immediate and noticeable, with benefit observed in 80 to 90 per cent of cases.
Return to basic daily activities is typically achieved within two to four weeks.
At the same time, appropriate medical treatment of the underlying osteoporosis is essential to reduce the risk of new fractures.
Possible side effects and complications
As with any surgical procedure, vertebroplasty and kyphoplasty carry certain risks, although these are uncommon. The most important is leakage of bone cement outside the vertebra, which in rare cases may compress neural structures.
Continuous fluoroscopic monitoring during the procedure allows immediate recognition and management of this complication. Other potential complications include wound infection, bleeding, reaction to the cement and, less commonly, an increased risk of fracture in adjacent vertebrae after stabilisation.
Kyphoplasty, because the cement is injected into a controlled, pre‑formed cavity, has a lower risk of leakage compared with vertebroplasty.
Dr Mazarakis
Specialist in minimally invasive spinal surgery
Vertebral fractures and their minimally invasive management form a substantial part of Dr Mazarakis’ clinical expertise, following comprehensive training at leading spinal surgery centres in the United Kingdom and Ireland.
He has long‑standing experience with both minimally invasive techniques, with excellent outcomes.
Dr Mazarakis sees patients in Athens and Thessaloniki, and the first consultation always aims to answer all questions and to select the treatment that best suits each individual patient.
