Percutaneous Vertebroplasty
Percutaneous vertebroplasty is a minimally invasive technique for painful vertebral compression fractures in which bone cement (usually PMMA) is injected directly into the fractured vertebral body through a small skin entry to stabilize the vertebra. It is most often used for osteoporotic compression fractures.
Última actualización: 2026-06-09
Definition
Vertebroplasty is a technique in which a collapsed vertebral body is reached through a small percutaneous skin entry and bone cement (often polymethylmethacrylate, PMMA) is injected directly into it under imaging guidance. The injected cement spreads within the vertebra and hardens to stabilize the fracture, with the aim of reducing pain. It differs from kyphoplasty in that no cavity is first created with a balloon and the cement is delivered directly into the bone.
Indications
Vertebroplasty is considered for painful vertebral compression fractures, most often osteoporotic, that are demonstrated on imaging and concordant with clinical findings. It is generally offered to patients who have not responded to an adequate trial of conservative treatment (analgesics, bracing, activity modification) or who are at risk of complications from immobility. It may also be used for selected tumor-related (metastasis, multiple myeloma) or traumatic fractures. Demonstrating that the fracture is recent and symptomatic (for example, with edema on MRI) is important for the decision.
Procedure
The procedure is usually performed under local anesthesia with sedation or general anesthesia, with the patient prone. Under fluoroscopic (imaging) guidance, a fine needle/cannula is advanced into the target vertebral body via a transpedicular or extrapedicular route. With the cannula correctly positioned, prepared bone cement is injected in a controlled manner into the vertebral body once its consistency is appropriate, under imaging control. Cement distribution is continuously monitored; injection is stopped when needed to reduce the risk of leakage. The cement is allowed to harden, the cannula is removed, and the small skin entry is closed.
Advantages and Limitations
Vertebroplasty is a minimally invasive procedure performed through a small skin entry and may allow early mobilization in many patients. Because it does not include a balloon step, it can be technically simpler and relatively shorter than kyphoplasty. However, because cement is delivered directly and at relatively higher pressure, the risk of cement leakage is a technique-specific limitation. Vertebroplasty does not aim to or guarantee restoration of vertebral height or spinal alignment. It may be unsuitable in marked instability, spinal cord or nerve compression, retropulsion of a fracture fragment into the canal, or active infection; such cases may require open surgery.
Recovery and Risks
Recovery time varies by patient and underlying condition; many patients mobilize relatively quickly. Possible risks include leakage of bone cement into adjacent structures, the epidural space, or a vessel, nerve or spinal cord injury, infection, bleeding, new fractures in adjacent vertebrae, and rarely cement embolism. Pain may not resolve completely or may partly persist. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, bone quality, imaging findings, and expectations together.
Referencias
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1212-1215.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2767-2769.
- Steinmetz MP, Berven SH, Benzel EC, eds. Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management. 5th ed. Elsevier; 2022:514-517.
- NICE Technology Appraisal Guidance TA279 — Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. 2013.
Este artículo es informativo y no sustituye un examen médico. Las decisiones de diagnóstico y tratamiento son individuales.