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Vertebroplasty for vertebral fractures

Vertebroplasty is a minimally invasive percutaneous procedure in which we inject bone cement (PMMA) directly into the body of a fractured vertebra, lumbar (L1–L5) or thoracic (T1–T12), to stabilise it and reduce pain. It is designed for patients with osteoporotic or pathological vertebral fractures (caused by tumour or metastasis) who continue to experience severe, disabling pain after 2–3 weeks of conservative treatment with rest, analgesia and, often, a brace. This guide explains what the procedure involves, when it is indicated at any spinal level, what the day of surgery looks like and what to expect afterwards, so you can decide calmly and with clear information.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Vertebroplasty illustration: percutaneous injection of PMMA cement into the body of a fractured lumbar vertebra through a transpedicular trocar.

What is vertebroplasty?

Vertebroplasty is a percutaneous technique in which, under image guidance, we introduce a needle or trocar through the pedicle of the fractured vertebra and inject bone cement (polymethylmethacrylate, or PMMA) directly into the vertebral body. The cement hardens in a few minutes, stabilises the microfractures and reduces pain. It can be performed at any thoracic (T1–T12) or lumbar (L1–L5) level.

Unlike kyphoplasty, which uses a balloon to create a cavity and partially restore vertebral height before injecting cement, vertebroplasty injects the PMMA directly, without a balloon. For that reason we reserve vertebroplasty for stable fractures without significant height loss, where the main goal is pain control and stabilisation of the vertebra. If you are unsure which option is best for your case, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from vertebroplasty typically describe:

Sharp back pain, localised over a specific vertebra (lumbar or thoracic), appearing after minimal effort or with no clear cause
Pain that clearly worsens on sitting up, standing or walking and eases somewhat with rest
Persistent pain beyond 2–3 weeks despite analgesia, rest and, when indicated, a brace
Loss of height, a stooped posture or new dorsal kyphosis
History of osteoporosis, long-term corticosteroid treatment or a diagnosis of a vertebral tumour or metastasis
Warning signs: leg weakness, sensory changes, problems controlling bowel or bladder, or fever associated with the pain

When is vertebroplasty indicated?

Stable osteoporotic vertebral fracture, at any thoracic or lumbar level, without significant height loss or instability
Pathological vertebral fracture from primary tumour or metastasis causing disabling pain
Severe focal pain confirmed clinically and by bone marrow oedema on MRI over the fractured vertebra
Persistent pain beyond 2–3 weeks despite conservative treatment (rest, analgesia, brace)
Patient without neurological compromise, without spinal canal invasion and without active infection at the level to be treated

How is the procedure performed?

1.Preoperative preparation

Before the vertebroplasty we review the MRI and, if needed, the CT scan to confirm that the fracture is recent (bone marrow oedema) and suitable for this technique. We check coagulation, adjust medication (especially anticoagulants) and provide fasting instructions. We answer your questions and plan together either a same-day discharge or a 24-hour stay depending on the case.

2.During the procedure

The patient lies face down. Vertebroplasty is usually performed under local anaesthesia and sedation, although in some cases we choose general anaesthesia. Under continuous fluoroscopic guidance we introduce one or two fine trocars through the pedicle into the vertebral body. At lumbar levels (L1–L5) the pedicle is wider and access is straightforward; at upper thoracic levels (T1–T8) we use an extrapedicular route when the pedicle is very small. Once the trocars are in position, we inject the PMMA cement with strict image control to avoid leakage. The procedure takes 30 to 60 minutes per level and requires no surgical incision — only two small skin punctures.

3.Immediate postoperative period

After the procedure patients remain lying down for 1 to 2 hours to let the cement fully harden. They then sit up and start walking with staff support. Most patients notice a clear improvement in pain within the first hours. Discharge is typically the same day or within 24 hours, depending on the patient's baseline status and pain control.

Recovery after vertebroplasty

Recovery is fast compared with open surgery. Most patients walk again on the same day and return to everyday activities within a few days.

During the first 2–4 weeks we ask patients to avoid heavy effort, lifting significant weight or sharp spinal flexion. In patients with osteoporosis, the underlying medical treatment (calcium, vitamin D, antiresorptive or anabolic drugs) is key to reducing the risk of new fractures at other levels. In oncological patients we coordinate the plan with their oncology and radiotherapy team.

Any recurrence of pain, fever, leg weakness or new neurological changes should be reviewed immediately.

Risks and possible complications

Any procedure carries general risks such as infection, bleeding, reaction to anaesthesia or cardiopulmonary complications.

The most characteristic risk of vertebroplasty is cement leakage outside the vertebral body. Most leakages are small and asymptomatic, but in rare cases they may affect veins, the disc, the spinal canal or the foramen, causing pain, nerve root irritation or, exceptionally, pulmonary cement embolism. Other possible risks include rib or pedicle fracture during the access, neurological injury and the appearance of new vertebral fractures at adjacent levels due to the underlying bone fragility. We assess each case individually and discuss the risks in detail before deciding.

Frequently asked questions

It works for both. The technique is essentially the same in the thoracic (T1–T12) and lumbar (L1–L5) spine: PMMA cement is injected into the fractured vertebral body under image guidance. In lumbar vertebrae the pedicle is wider and access is often even more straightforward. What decides the indication is not the level but whether the fracture is stable, recent and the source of your pain.
In vertebroplasty we inject the PMMA cement directly into the fractured vertebra. In [kyphoplasty](/en/treatments/kyphoplasty) we first introduce a balloon that is inflated to create a cavity and partially restore the vertebral body height before injecting the cement. We therefore reserve kyphoplasty for fractures with more pronounced height collapse and vertebroplasty for stable fractures focused on pain control. We decide together which technique best fits your case.
In older patients with a recent osteoporotic vertebral fracture and severe persistent pain after 2–3 weeks of conservative treatment, vertebroplasty is often a suitable option, whether the fracture is lumbar or thoracic. It is a short procedure, performed under local anaesthesia and sedation, and it allows fast recovery of mobility. We always review the MRI, the general health status and the underlying treatment before recommending it.
Vertebroplasty usually takes between 30 and 60 minutes per level. We typically use local anaesthesia with sedation, which is especially helpful in older patients or those with comorbidities. In selected cases we choose general anaesthesia.
Most patients are discharged on the same day or within 24 hours. After the procedure you lie down for 1–2 hours while the cement hardens and we then help you walk on the ward. If pain control is good and the case allows it, you go home quickly.
Many patients notice a clear improvement in pain within the first hours or first days. The response is not identical in everyone, but early pain relief is one of the most characteristic effects of this technique.
Yes, especially when the underlying cause is osteoporosis or a tumour process. That is why, besides treating the fractured vertebra, it is essential to optimise the medical treatment of the bone (osteoporosis) or to coordinate with the oncology team (tumour process) to reduce that risk.

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Do these symptoms sound familiar?

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