As life expectancy increases, spinal problems are also becoming more frequent. Vertebral compression fractures, in particular those caused by bone loss (osteoporosis), are a health problem that seriously affects patients’ quality of life. In this article, I would like to explain two modern methods successfully applied in the treatment of spinal fractures — kyphoplasty and vertebroplasty — in clear and understandable terms.
What Is a Vertebral Compression Fracture?
The spine is made up of bony structures (vertebrae) stacked on top of one another. Due to causes such as bone loss, tumors, or trauma, these bones can weaken and collapse inward. This is called a vertebral compression fracture, or in common terms, a “spinal collapse fracture.”
Compression fractures generally present with symptoms such as severe pain in the back and lower back, loss of height, forward bending and hunchback (kyphosis), marked limitation in daily activities, and difficulty standing and walking.
These fractures are most commonly seen in women over the age of 60 and in osteoporosis patients. However, they can also occur in younger patients in situations such as cancer that has spread to the bones (metastasis) or falls from height.
What Is Vertebroplasty?
Vertebroplasty is a minimally invasive procedure based on strengthening the bone and relieving pain by injecting a special bone cement (PMMA) into the fractured vertebral bone. It is also commonly known as “spinal cement” or “spinal filling.”
How Is the Procedure Performed?
In the operating room setting, the patient lies in a prone (face-down) position. Local anesthesia and mild sedation are applied; that is, the patient is awake but does not feel pain. The fractured vertebra is identified with the guidance of a fluoroscopy (X-ray) device. A small incision of a few millimeters is made in the skin, and the fractured bone is reached with a special needle. Bone cement is then injected to reinforce the fractured bone.
The procedure usually takes 30–45 minutes. The patient can be discharged the same day or the next day.
What Is Kyphoplasty?
Kyphoplasty is an improved version of vertebroplasty. The main difference is that, before the cement injection, a special balloon is placed inside the fractured bone and inflated to restore the height of the collapsed bone.
Procedure Steps
The fractured vertebra is entered with a needle under local anesthesia. A small balloon is placed and inflated. By means of the balloon, the collapsed bone is lifted and brought closer to its former height. Finally, the balloon is removed and bone cement is injected into the resulting cavity.
The most important advantage of kyphoplasty over vertebroplasty is that it can partially restore the height of the bone and prevent the development of a hunchback. In addition, because the cement is injected at low pressure thanks to the balloon, the risk of cement leaking into the spinal canal is lower.
Differences Between the Two Methods
| Feature | Vertebroplasty | Kyphoplasty |
|---|---|---|
| Balloon use | No | Yes |
| Height restoration | Limited | More effective |
| Cement leakage risk | Relatively high | Lower |
| Suitable patient group | Older fractures | Newer fractures (especially first 4–6 weeks) |
| Hunchback correction | Limited | More successful |
Which Patients Is It Applied To?
Kyphoplasty and vertebroplasty may be considered in the following situations:
Vertebral compression fractures due to osteoporosis: This is the most common area of application. It is an effective solution for painful fractures resulting from bone loss.
Cancer-related spinal fractures: Used in fractures caused by tumors that have spread to the bones, both for pain control and bone reinforcement.
Pain unresponsive to medication: May be applied in patients whose pain persists despite at least 3–4 weeks of conservative methods such as painkillers, a brace, and bed rest.
The Post-Procedure Process
Because these procedures are minimally invasive, the recovery process is quite short. The vast majority of patients can stand up a few hours after the procedure and are usually discharged the same day or the next day. A significant portion of patients feel a marked reduction in their pain from the first days after the procedure. A return to daily activities is possible within a few days. However, avoiding heavy lifting and strenuous physical activity for a few weeks is recommended.
Are There Risks to the Procedure?
As with every surgical procedure, kyphoplasty and vertebroplasty also carry some risks; however, the rate of serious complications is quite low. Possible risks include infection, bleeding, leakage of cement into surrounding tissues, and very rarely nerve damage. In experienced hands and with appropriate patient selection, the great majority of these risks can be minimized.
Frequently Asked Questions
Is the procedure painful? Because it is performed under local anesthesia and sedation, no pain is felt during the procedure. There may be mild pain afterward; however, this is usually brought under control with simple painkillers.
Can it be applied to every spinal fracture? No. The type of fracture, its duration, the patient’s general condition, and accompanying illnesses must be evaluated. A spine surgeon must always decide which treatment is appropriate.
How long after the fracture should it be performed? The best results are obtained within the first few weeks of the fracture. Particularly in kyphoplasty, early intervention is important for height restoration to be successful. In fractures older than six months, the success rate may decline.
Can elderly patients tolerate this procedure? Yes. Because it does not require general anesthesia and is minimally invasive, it is a particularly suitable option for elderly individuals and those with chronic illnesses who cannot tolerate open surgery.
Conclusion
Kyphoplasty and vertebroplasty are safe and effective treatment methods applied in vertebral compression fractures to rapidly relieve patients’ pain and improve their quality of life. The fact that they do not require open surgery, take a short time, and provide rapid recovery are the most important advantages of these methods.
I particularly recommend that my patients who have bone loss and suffer from back and lower-back pain not ignore their complaints and consult a spine surgeon at an early stage. Early diagnosis and timely intervention are the most critical factors directly affecting the success of treatment.
This article has been prepared for general informational purposes. Treatment decisions must always be made after examination and evaluation by a specialist physician.
Prof. Dr. Mehmet Şenoğlu — Specialist in Neurosurgery