Vertebral augmentation, which includes vertebroplasty and kyphoplasty, are similar spinal procedures in which bone cement is injected through a small hole in the skin into a fractured vertebra to try to relieve back pain caused by a vertebral compression fracture. It was found not to be effective in treating osteoporosis-related compression fractures of the spine. The people in both the experimental and placebo groups reported improvement in their pain, suggesting that the benefit is related to the placebo effect. As of 2019, routine use is thus not recommended.
Vertebroplasty is typically performed by a spine surgeon or interventional radiologist. It is a minimally invasive procedure and patients usually go home the same or next day as the procedure. Patients are given local anesthesia and light sedation for the procedure, though it can be performed using an only local anesthetic for patients with medical problems who cannot tolerate sedatives well.
During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra. The needle is placed with fluoroscopic x-ray guidance. The cement (most commonly PMMA, although more modern cement are used as well) quickly hardens and forms a support structure within the vertebra that provides stabilization and strength. The needle makes a small puncture in the patient’s skin that is easily covered with a small bandage after the procedure.
Kyphoplasty is a variation of vertebroplasty which attempts to restore the height and angle of kyphosis of a fractured vertebra (of certain types), followed by its stabilization using injected bone cement. The procedure typically includes the use of a small balloon that is inflated in the vertebral body to create a void within the cancellous bone prior to cement delivery. Once the void is created, the procedure continues in a similar manner as vertebroplasty, but the bone cement is typically delivered directly into the newly created void.
In a 2011 review, Medicare contractor NAS determined that there is no difference between vertebroplasty and kyphoplasty, stating, “No clear evidence demonstrates that one procedure is different from another in terms of short- or long-term efficacy, complications, mortality or any other parameter useful for differentiating coverage.
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