Vertebral augmentation is a minimally invasive medical procedure aimed at treating vertebral compression fractures (VCFs) and alleviating the pain and disability associated with them. VCFs can result from osteoporosis, trauma, or other medical conditions, and they often cause significant discomfort and decreased quality of life. In this article, we will explore the technical aspects, history, and evolution of vertebral augmentation, along with its indications, available equipment, procedure steps, post-procedure recovery, success rates, controversial issues, and potential risks and complications.

Technical Aspect

Vertebral augmentation primarily involves two techniques: vertebroplasty and kyphoplasty.

1. Vertebroplasty:
– During this procedure, a special bone cement (usually polymethylmethacrylate or PMMA) is injected directly into the fractured vertebral body.
– The cement hardens within minutes, stabilizing the fractured vertebra and providing immediate pain relief.

2. Kyphoplasty:
– Kyphoplasty is a more advanced technique, involving the use of a balloon catheter to create a cavity within the fractured vertebral body.
– Once the cavity is formed, the same bone cement is injected, creating a space that can be restored to its original height, reducing spinal deformity.

History and Evolution

Vertebral augmentation techniques were first introduced in the 1980s and have evolved considerably since then. Early methods lacked the precision and technology available today. The introduction of kyphoplasty marked a significant advancement, enabling better height restoration and improved pain relief.


Vertebral augmentation is indicated for the following conditions:
1. Painful vertebral compression fractures due to osteoporosis.
2. Compression fractures resulting from malignancies such as spinal metastases.
3. Painful traumatic fractures.
4. Fractures that have not responded to conservative treatment.


Various specialized instruments are used in vertebral augmentation, including:
1. C-arm fluoroscopy for real-time imaging guidance.
2. Bone cement delivery systems.
3. Balloon catheters (for kyphoplasty).
4. Needles and trocars for cement delivery.

Procedure Steps

1. Patient Preparation:
– Patient evaluation and consent.
– Positioning on the procedure table.

2. Imaging:
– Utilization of C-arm fluoroscopy for precise needle placement.

3. Needle Insertion:
– A needle is inserted into the fractured vertebra under guidance.

4. Cement Injection:
– PMMA cement or similar materials are injected into the vertebral body.

5. Balloon (Kyphoplasty, if applicable):
– If kyphoplasty is performed, a balloon catheter is inserted, inflated, and deflated to create a cavity for cement injection.

Post-procedure Recovery

Recovery varies from patient to patient but often involves:
1. Observation in a recovery area.
2. Pain management and monitoring for potential complications.
3. Mobilization as soon as possible to prevent complications associated with immobility.
4. Rehabilitation exercises and potential physical therapy.

Success Rate

The success rate of vertebral augmentation is generally high, with most patients experiencing significant pain relief and improved quality of life. However, success may vary depending on the underlying cause of the fracture, the timing of the intervention, and the patient’s overall health.

Controversial Issues

1. Timing of the procedure: Some debate exists about the ideal timing of vertebral augmentation, particularly in osteoporotic fractures.
2. Cement leakage: Potential complications include cement leaking into surrounding tissues, although this is generally rare and well-managed by experienced practitioners.
3. Long-term outcomes: The long-term durability of pain relief and the integrity of the cement are subjects of ongoing research.

Risks & Complications

While vertebral augmentation is a safe and effective procedure, there are potential risks and complications, including:
1. Infection.
2. Cement leakage.
3. Nerve or blood vessel injury.
4. Allergic reactions.
5. Fracture of adjacent vertebrae.

Although risks related to kyphokplasty are rare, serious complications can occur, including spinal cord compression, nerve root compression, venous embolism, and pulmonary embolism, including cardiovascular collapse. According to the American Association of Neurological Surgeons, Kyphoplasty complication rates are at less than 2% for osteoporotic VCF’s, and up to 10% for malignant tumor-related VCF’s.


Vertebral augmentation, through vertebroplasty and kyphoplasty techniques, offers a minimally invasive solution to alleviate the pain and disability caused by vertebral compression fractures. With advancements in equipment and techniques, the procedure has become safer and more effective. While it’s not without controversy and potential risks, its high success rate and ability to improve patients’ quality of life make it a valuable option for those suffering from painful VCFs. Always consult with a medical professional to determine the best treatment approach for your specific condition.

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