Vertebral compression fractures are a common cause of significant and life-altering spinal pain and are seen increasingly in clinics with the aging of the United States population. Vertebral compressions may result from bone weakening and osteoporosis, underlying bony pathology, such as metastasis or myeloma, or trauma. While some fractures heal spontaneously, many progress to chronic pain syndromes, which can result in decreased ambulation, depression, immobility, and inability to perform simple activities of daily living.  Vertebroplasty, an image-guided invasive spinal technique for pain related to acute painful vertebral fractures or related to metastases. In subsequent years, evolution of the techniques of vertebroplasty, and expansions of indications, have resulted in several useful vertebral augmentation procedures that have been demonstrated to be effective means of decreasing the pain resulting from these fractures and may have some role in decreasing deformity related to the fractures as well.


Vertebroplasty, the percutaneous administration of acrylic bone cement into a vertebral body, was developed in France in 1984, initially as a treatment for a painful vertebral hemangioma. Subsequent adaptations of the technique, development of materials and devices have led to many vertebral augmentation variants that have proven highly successful in treating pain related to osteoporotic compression fractures and vertebral body pathology, such as metastasis and myeloma. Vertebroplasty involves the image-guided placement of a needle into the bone of the affected vertebral body, followed by injection of the bone cement under x-ray imaging to assure appropriate placement of the cement. Supplemental techniques, such as the use of a balloon to create a cavity in the vertebral body (kyphoplasty) , and attempt restoration of height have also been developed. The indications for the procedure, potential risks, and basics of the technique are reviewed here. With careful attention to technique, vertebral augmentation is a very safe and highly effective treatment for back pain related to vertebral body compression and bony pathology.

Kyphoplasty is a vertebroplasty except a balloon is inserted in the fractured vertebra, inflated to break up microtrabecula of the bone in order to be better able to fill the fractured vertebra with cement.

X ray shows needle in fractured vertebra followed with insertion of cement. Schematic shows how we place the needle through the pedicle into the vertebra and fill with cement. This is all done by x-ray guidance.

Fracture in the sacrum as denoted by arrows in figure 1. A bone scan in figure 2 highlights in black confirmation of an acute fracture. Utilizing CT  figure 3 in a prone position a needle is in the right sacrum and filled with cement to secure the fracture. This procedure helps significantly with relieving pain. 
Sacroplasty is indicated for the treatment of severe, debilitating low back and sacral pain related to sacral insufficiency fracture or other underlying sacral lesion. Sacral stabilization with sacroplasty may be performed for primary or metastatic neoplasms of the sacrum or nonneoplastic lesions of the sacrum, such as cysts.