Vertebroplasty: bone cement for painful spinal fractures explained

The spine is made of bones called vertebrae. NICE explains that a vertebral compression fracture usually occurs when the front of the vertebral body collapses, and may be caused by trauma, cancer or osteoporosis. Osteoporotic compression fractures can cause the spine to curve and lose height and can result in pain, difficulties in breathing, gastrointestinal problems, sleep disturbance and difficulty with daily activities.

Vertebroplasty is one of the procedures used for such fractures. NICE describes it as injecting bone cement into the vertebral body using local anaesthetic and an analgesic, with the aims of relieving pain in people with painful fractures and strengthening the bone to prevent future fractures. A related procedure, balloon kyphoplasty, inserts a balloon-like device to try to restore the height of the vertebra before the space is filled with cement.

The NHS says osteoporosis weakens bones, making them fragile and more likely to break, develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a fracture. The most common injuries are a broken wrist, hip or spinal bones (vertebrae). Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine, and broken bones in the spine are a common cause of long-term pain.

NICE says the prevalence of vertebral fractures increases with age and they are more common in women, and that not all fractures come to the attention of clinicians because they are not always recognised on X-rays. Treating them aims to restore mobility, reduce pain and minimise the incidence of new fractures, and non-invasive treatment includes pain medication, bed rest and back braces.

NICE technology appraisal guidance (TA279, 2013) says percutaneous vertebroplasty, and balloon kyphoplasty without stenting, are recommended as options for osteoporotic vertebral compression fractures only in people who have severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management, and in whom the pain has been confirmed to be at the level of the fracture by physical examination and imaging.

NICE’s interventional procedures guidance, summarised in the technology appraisal, notes that patients should receive these procedures only after discussion with a specialist multidisciplinary team, and in a facility that has access to a spinal surgery service. For vertebroplasty it adds that the procedure should be limited to people whose pain does not respond to more conservative treatment.

The sources used here give only a short description of the procedure itself. NICE says vertebroplasty involves injecting bone cement into the vertebral body, the solid part of the vertebra, using local anaesthetic and an analgesic, and that it is intended to relieve pain in people with painful fractures and to strengthen the bone.

The NICE texts used here do not specify timings, positioning or recovery details, so your own team will explain the plan, how long you should rest afterwards and when you can return to normal activity. Because of the risks listed below, NICE says it should take place in a suitably equipped facility with access to spinal surgery.

NICE lists adverse reactions for both vertebroplasty and kyphoplasty. Needle insertion can cause local or systemic infection, bleeding and damage to neural or other structures. Other problems include leakage of bone cement, displacement of bone marrow and other material by the cement, and systemic reactions to the cement such as hypotension and death. There are also complications related to anaesthesia and patient positioning, such as additional fractures of a rib or the sternum, and a small risk that the balloon can rupture in kyphoplasty.

These risks are why the recommendation is restricted to people with severe pain that has not responded to other measures. They should be discussed in detail with the specialist team, including any risks specific to you, such as bleeding tendency, infection or cement leakage close to the spinal canal.

A cement procedure treats one fracture, not the osteoporosis. The NHS says treating osteoporosis involves treating and preventing fractures and using medicines to strengthen bones, and that if you have been diagnosed because you broke a bone you should still receive treatment to try to reduce your risk of further fractures.

It lists bisphosphonates, raloxifene for some women after the menopause, parathyroid hormone treatments, biological medicines such as denosumab and romosozumab, calcium and vitamin D supplements, and HRT in some women. The recommended amount of calcium for most healthy adults is 700 mg a day and adults should have 10 micrograms of vitamin D a day, with supplements considered in autumn and winter.

NICE’s appraisal is cautious, restricting the use to a narrow group, and the sources do not give outcome percentages for pain relief. Many fractures settle with time and conventional pain management, which is the first approach.

Access is through the NHS via a GP or hospital specialist. Private providers also offer the procedure in general terms, but the NICE criteria are a useful benchmark for whether it is appropriate for you.