Kyphoplasty vs. Vertebroplasty: Which Treatment Is Used for Spinal Compression Fractures?

Spinal compression fractures can cause significant back pain, limit mobility, and make everyday activities difficult. These fractures often occur when weakened vertebrae collapse, frequently because of osteoporosis, although traumatic injuries and certain cancers can also damage the bones of the spine. For patients whose pain does not improve with conservative treatment, minimally invasive procedures such as kyphoplasty and vertebroplasty may offer another option.

Although both procedures stabilize fractured vertebrae using bone cement, they differ in how the cement is delivered and whether an attempt is made to restore vertebral height. Understanding the differences between kyphoplasty and vertebroplasty can help patients better understand their treatment options and the factors a physician considers when recommending a procedure.

What Is a Spinal Compression Fracture?

A spinal compression fracture occurs when a vertebra, one of the bones that forms the spine, collapses partially or completely. The resulting change in the bone’s structure can cause pain, reduced mobility, and changes in posture.

Osteoporosis is one of the most common causes of spinal compression fractures. When bone density decreases, vertebrae become more vulnerable to fractures, sometimes during routine activities such as bending, lifting, or coughing. Compression fractures can also result from falls, other traumatic injuries, or cancer that weakens the spinal bones.

Common symptoms of a spinal compression fracture include:

• Sudden or gradually worsening back pain
• Pain that increases when standing, walking, or changing positions
• Tenderness over the affected area of the spine
• Reduced mobility or difficulty performing everyday activities
• Loss of height or a forward-stooped posture when multiple fractures occur

Some compression fractures cause few noticeable symptoms and are discovered incidentally during imaging. When a fracture causes persistent pain, a physician may recommend diagnostic imaging and evaluate whether the fracture is responsible for the patient’s symptoms.

What Is Vertebroplasty?

Vertebroplasty is a minimally invasive procedure used to stabilize a painful spinal compression fracture. During the procedure, a physician inserts a specialized needle through the skin and into the fractured vertebra, typically using imaging guidance to ensure accurate placement.

The physician then injects medical-grade bone cement into the damaged bone. The cement hardens, helping stabilize the fracture and reduce painful movement within the vertebra.

Vertebroplasty generally does not attempt to restore the height of a collapsed vertebra. Its primary purpose is to reinforce the weakened bone and stabilize the fracture.

The procedure is usually performed through a small skin puncture rather than a large surgical incision. Depending on the patient’s circumstances and the facility’s protocol, local anesthesia with sedation or general anesthesia may be used.

What Is Kyphoplasty?

Kyphoplasty is another minimally invasive procedure designed to stabilize a painful spinal compression fracture. Like vertebroplasty, it uses bone cement to reinforce the damaged vertebra. However, kyphoplasty includes an additional step that may help restore some of the vertebra’s lost height.

During kyphoplasty, the physician inserts a needle into the fractured vertebra and advances a small balloon into the bone. The balloon is carefully inflated to create a cavity and, in selected cases, partially restore the vertebral body’s height. The balloon is then deflated and removed, and bone cement is injected into the resulting space.

Kyphoplasty may help reduce pain and stabilize the fracture while potentially improving vertebral alignment. However, the degree of height restoration varies, and the procedure cannot always correct an established spinal deformity.

As with vertebroplasty, kyphoplasty is performed using imaging guidance and generally requires only small skin incisions or punctures.

What Is the Difference Between Kyphoplasty and Vertebroplasty?

The primary difference between kyphoplasty and vertebroplasty is how the physician prepares the fractured vertebra before injecting bone cement.

Vertebroplasty involves injecting cement directly into the fractured bone to stabilize it. Kyphoplasty uses an inflatable balloon before cement injection, potentially creating space for the cement and restoring some vertebral height.

Other differences may influence the treatment decision.

Vertebral height restoration: Kyphoplasty may restore some of the height lost during a compression fracture. Vertebroplasty is primarily intended to stabilize the bone rather than restore its shape.

Cement delivery: Vertebroplasty involves injecting cement directly into the vertebra. Kyphoplasty creates a cavity with a balloon before cement is introduced.

Cement leakage: Both procedures carry a risk of cement leakage outside the vertebra. The balloon-created cavity used in kyphoplasty may allow cement to be injected at a lower pressure, but it does not eliminate this risk.

Treatment goals: Both procedures aim to stabilize the fracture and potentially relieve pain. Kyphoplasty may offer an additional benefit when restoring some vertebral height is an important treatment goal.

Neither procedure is automatically better for every patient. The appropriate approach depends on the fracture’s characteristics, the patient’s symptoms, bone health, and other clinical factors.

Which Procedure Is Better for Spinal Compression Fractures?

Neither kyphoplasty nor vertebroplasty is universally considered the best treatment for every spinal compression fracture. The decision depends on the patient’s condition and whether the expected benefits of the procedure outweigh its risks.

Kyphoplasty may be considered when a recent compression fracture has caused substantial vertebral height loss or when partial height restoration is a treatment goal. Vertebroplasty may be considered when stabilizing the fractured bone is the primary objective and restoring vertebral height is less important.

However, the choice is not based on vertebral height alone. The age of the fracture, evidence of ongoing activity within the fracture, severity of pain, spinal anatomy, and other medical conditions can influence the recommendation.

It is also important to understand that vertebral augmentation is not necessary for every compression fracture. Many fractures improve over time with conservative care, which may include appropriate pain management, temporary activity modification, bracing in selected cases, and treatment for underlying osteoporosis.

Research on the benefits of vertebroplasty has produced mixed results, particularly for routine treatment of osteoporotic fractures. As a result, physicians carefully evaluate patient selection rather than assuming that every painful compression fracture will benefit from cement augmentation.

Who May Be a Candidate for Kyphoplasty or Vertebroplasty?

Patients with painful spinal compression fractures that have not improved sufficiently with conservative treatment may be evaluated for kyphoplasty or vertebroplasty.

Potential candidates often have imaging-confirmed fractures that correspond to their symptoms. A physician may use X-rays, MRI, or CT scans to assess the location and severity of the fracture, determine whether it appears recent or active, and evaluate the surrounding spinal structures.

Factors that may support consideration of either procedure include:

• Persistent, significant pain that limits daily activities
• A recent osteoporotic compression fracture associated with localized pain
• Difficulty standing, walking, or participating in rehabilitation because of fracture-related discomfort
• Inadequate improvement with an appropriate trial of nonsurgical treatment

Not every patient is a suitable candidate. Fractures involving certain types of instability, significant spinal canal compromise, or neurological problems may require a different treatment approach. Infection, bleeding risks, and other medical conditions can also affect eligibility.

A thorough evaluation helps determine whether vertebral augmentation, continued conservative care, or another intervention is most appropriate.

What Are the Risks of Kyphoplasty and Vertebroplasty?

Kyphoplasty and vertebroplasty are generally considered minimally invasive procedures, but both have potential complications. Patients should discuss the risks with their treating physician before proceeding.

Possible complications include bone cement leakage, bleeding, infection, nerve irritation or injury, and complications related to anesthesia. Rarely, leaked cement can enter nearby blood vessels and travel to the lungs.

There is also a possibility that the procedure will not provide adequate pain relief. Patients with multiple fractures, chronic spinal pain from another source, or an older fracture that has already healed may have different outcomes than patients with a recent, painful fracture.

Additional compression fractures can occur after treatment, particularly in people with osteoporosis. These fractures may develop in adjacent vertebrae or elsewhere in the spine, although the relationship between vertebral augmentation and subsequent fractures is not fully established.

Treating the underlying cause of weakened bones remains important regardless of which procedure is selected.

What Is Recovery Like After Kyphoplasty or Vertebroplasty?

Recovery after kyphoplasty or vertebroplasty is often shorter than recovery after open spinal surgery because both procedures use small punctures rather than large incisions.

Many patients are monitored for several hours and may return home the same day, depending on their medical condition and the facility’s protocols. Some experience pain relief relatively quickly, while others improve gradually over the following days or weeks. Individual results vary, and neither procedure guarantees complete pain relief.

Physicians provide instructions about activity restrictions, wound care, and when normal activities can be resumed. Patients may need to avoid strenuous lifting or other activities temporarily while following a personalized recovery plan.

Long-term management may include osteoporosis treatment, appropriate exercise, fall prevention, and nutritional measures that support bone health. Follow-up care helps evaluate recovery and address risk factors for future fractures.

How Can You Determine Which Compression Fracture Treatment Is Right for You?

Choosing between kyphoplasty and vertebroplasty requires an individualized assessment of the fracture, its cause, and the patient’s overall health. A physician will consider imaging findings, pain severity, functional limitations, the response to conservative treatment, and the potential risks and benefits of each option.

For some patients, vertebral augmentation may provide meaningful pain relief and improve mobility when a compression fracture remains painful despite nonsurgical care. For others, conservative treatment or a different intervention may be more appropriate.

Anyone experiencing new or persistent back pain, particularly after a fall or with a history of osteoporosis, should seek medical evaluation. Sudden severe back pain accompanied by new leg weakness, numbness in the groin or saddle region, or loss of bladder or bowel control requires emergency assessment.

Understanding the differences between kyphoplasty and vertebroplasty is an important step toward making an informed treatment decision and developing a plan that addresses both fracture-related pain and long-term spinal health.