Vertebroplasty is an interventional radiology (IVR) procedure in which a thin needle is used to fill a collapsed vertebra with medical bone cement so that it sets firm. It treats painful spinal compression fractures caused by osteoporosis, and fractures in bones weakened by spinal metastases or multiple myeloma. The main candidates are people with a recent fracture that stays painful despite good pain medication, and many report that their pain eases markedly within 48 hours.
Randomized trials support the benefit. In the Australian VAPOUR trial, 44% of patients in the vertebroplasty group had pain below 4 out of 10 at day 14, compared with 21% in the control group. This guide explains how the procedure works, who it suits, the steps and recovery time, side effects, and availability in Japan and other countries.
Treatment status · Established treatment. The UK National Institute for Health and Care Excellence (NICE) recommended vertebroplasty and balloon kyphoplasty as options for osteoporotic compression fractures in its 2013 guidance (TA279), and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) describes them as standard procedures in its patient information. Balloon kyphoplasty has also been used in Japan since the early 2010s. This article is general information, not a recommendation.
What is vertebroplasty?
The rounded front part of each spinal bone, the vertebral body, can be squashed flat when osteoporosis or cancer weakens it. This is a compression fracture. Each time the broken fragments move, the back hurts badly, making it hard to turn in bed, stand up or walk.
In vertebroplasty, the doctor watches X-ray images and guides a needle into the vertebral body without an open incision. Thick bone cement (PMMA) is then injected through the needle; it hardens inside the bone and supports the fracture from within. Once the loose fragments are fixed, pain decreases. There are two main versions.
| Item | Vertebroplasty | Balloon kyphoplasty |
|---|---|---|
| Method | Cement injected directly through the needle | A balloon is inflated to create a space, then cement is injected |
| Features | Thin needle, simpler procedure | May help restore some of the lost height |
| Usually performed by | Interventional radiologists | Spine surgeons and interventional radiologists |
| Anesthesia | Local anesthesia and sedation | Local anesthesia and sedation, or general anesthesia |
Based on CIRSE patient information and the Ontario Health Technology Assessment (2016).
The Ontario assessment notes that both are image-guided procedures done through the skin, and that usually three or four vertebrae at most are treated in one session. Other needle-based IVR procedures are covered in our IVR (interventional radiology) guide.
Who is it for?
NICE defines candidates clearly: people with a recent, unhealed vertebral fracture who still have severe pain despite optimal pain management, and in whom examination and imaging confirm that the pain comes from the fracture level. Newer fractures respond better than old ones.
- Osteoporotic compression fractures: a fracture after a minor fall or even a cough, with pain lasting several weeks
- Spinal metastases: cancers such as breast, lung, kidney or prostate cancer spreading to the spine and weakening the bone
- Multiple myeloma: fractures caused by myeloma eroding the vertebral body
Swelling inside the bone (bone marrow edema) on MRI signals a fresh, unhealed fracture and helps decide suitability. If there is infection at the site, uncontrolled bleeding tendency, or a fragment pressing on nerves, other treatments are considered first. Cancer patients sometimes have radiofrequency or cryoablation as well; see our guide to ablation for bone metastasis pain.
The procedure takes about an hour
According to WakeMed in the United States, each vertebra takes about one hour. Most patients go home the same day; frail patients or those with other conditions may stay overnight.
| Step | What happens |
|---|---|
| Before | Blood tests, MRI or other imaging, review of blood thinners such as aspirin or warfarin, fasting from the night before |
| Position and anesthesia | Lying face-down, local anesthetic in the skin of the back, sedation or general anesthesia if needed |
| Needle placement | The needle is guided into the vertebral body with X-ray (and CT if needed) |
| Cement injection | Cement is filled slowly while its spread is watched on images (in kyphoplasty a balloon creates the space first) |
| After | Rest and monitoring for 2 to 6 hours depending on the hospital, then discharge |
Combines CIRSE patient information (2 hours of monitoring after local anesthesia) and WakeMed guidance (about 6 hours lying still). Actual times follow hospital policy.
You cannot drive home, so a companion should come with you. Bringing a list of your medicines and supplements helps the team decide quickly which ones to pause.
Recovery time and daily care
A key advantage is fast recovery. WakeMed reports that many patients feel relief right away, most say their pain is gone or much better within 48 hours, and most return to normal activity within 24 hours.
| Time | Guidance |
|---|---|
| Same day | Rest lying down, deep-breathing exercises |
| Days 1–2 | Ice the needle site (15 minutes each hour, with a cloth), start walking |
| Next few days | Shower with the bandage on, increase activity gradually |
| Until your doctor allows | Avoid lifting, pushing or pulling heavy objects |
After an osteoporotic fracture, bone-strengthening medicine and fall prevention remain important. The cement supports only the treated bone, so care continues to protect the other vertebrae. For cancer patients, the care team coordinates the timing with radiotherapy or chemotherapy.
What studies have shown
Randomized trials and large analyses have repeatedly reported improvements in pain and daily function. Key studies are summarized below.
| Study | Participants | Main results |
|---|---|---|
| VAPOUR randomized trial (Australia, Lancet 2016) | 120 people with severe osteoporotic fractures under 6 weeks old | Pain below 4 at day 14: 44% vertebroplasty vs 21% control. Median hospital stay 5.5 days shorter among inpatients |
| CAFE randomized trial (22 sites, Lancet Oncology 2011) | 134 cancer patients with spinal compression fractures | Back function score (0–24) improved by 8.3 points at 1 month with kyphoplasty vs 0.1 in controls |
| Multiple myeloma pooled analysis (Mayo Clinic, 2014) | 23 studies, 923 patients | Pain on a 10-point scale fell 4.8 points within 1 week and stayed 4.4 points lower beyond 1 year |
| Ontario Health Technology Assessment (Canada, 2016) | 111 reports, 4,235 patients with cancer-related fractures | Pain scores fell significantly with both procedures, and painkiller use decreased |
Figures are as reported in the original papers. The VAPOUR control was a placebo procedure; the CAFE control was usual non-surgical care.
In the myeloma analysis, painkiller use fell by 81.9% within a week, and pain relief was the same with vertebroplasty and kyphoplasty. For people with cancer, needing fewer painkillers and regaining time sitting and walking helps them continue their other treatment.
Side effects and how they are managed
The most common finding is a small cement leak outside the bone. In the Mayo Clinic analysis, CT showed leaks in 23% of treated vertebrae, but most caused no symptoms and were not linked to pain. This is why the cement is injected while its spread is watched on images.
| Side effect | Frequency and features | Management |
|---|---|---|
| Symptom-free cement leak | Common (23% of vertebrae on CT) | Usually needs no treatment |
| New fracture in another vertebra | 7.3% vertebroplasty, 6.8% kyphoplasty | Osteoporosis medicine, fall prevention |
| Infection, pulmonary embolism, nerve symptoms | Each under 1% | Contact the team at once for fever, breathlessness or leg numbness |
| Needle-site soreness | A few days | Ice packs, pain relief |
Based on the pooled analysis of 923 myeloma patients (AJNR 2014) and CIRSE patient information.
CIRSE explains that large leaks needing surgery or nerve injury are rare. Side effects of other local treatments such as radiofrequency ablation are covered in our guide to RFA side effects.
Availability in Japan and abroad
| Region | Status |
|---|---|
| United Kingdom | Recommended for osteoporotic compression fractures in NICE guidance TA279, available in the NHS |
| Europe | Presented by CIRSE as a standard procedure, widely performed by interventional radiologists |
| United States | Offered as a same-day procedure by interventional radiology and spine surgery teams in university and community hospitals |
| Japan | Balloon kyphoplasty used since the early 2010s; a 2016 review in a Japanese spinal surgery journal summarized five years of results |
If you are being treated in Japan, the quickest step is to ask the orthopedic or radiology department at your current hospital. If you plan an overseas consultation, gather recent spine MRI and X-rays, bone density results, blood tests and, for cancer patients, your treatment history. Public insurance often does not cover international patients, so confirm costs and waiting times directly with the hospital.
Questions to ask your doctor
- Does my MRI show a fresh, unhealed fracture?
- Which suits me better, vertebroplasty or balloon kyphoplasty?
- How many vertebrae will be treated at once, and will I need to stay in hospital?
- When should I stop and restart my blood thinners?
- If I have cancer, would radiotherapy or radiofrequency ablation help alongside it?
To prepare for a consultation, see also five questions before an RFA consultation. Needle-based tumor ablation is explained in our RFA (radiofrequency ablation) guide.
Frequently asked questions
How long is the recovery after vertebroplasty?
Most people go home the same day and return to normal activity within 24 hours. Many feel much less pain within 48 hours. Avoid heavy lifting until your doctor says it is fine.
What is the difference between vertebroplasty and kyphoplasty?
Vertebroplasty injects cement directly through the needle, while kyphoplasty first creates a space with a balloon. In the analysis of 923 myeloma patients, pain relief was the same with both. Doctors choose based on the fracture shape and height.
Can it be done when cancer has spread to the spine?
Yes. In the CAFE trial of 134 cancer patients, those treated with balloon kyphoplasty improved their back function score by 8.3 points at one month. It may be planned together with radiotherapy or radiofrequency ablation.
Does the cement stay in the body permanently?
Yes. The bone cement stays hardened inside the bone and keeps supporting the fracture. It is a long-established medical material, and bone health care continues afterwards to prevent new fractures in other vertebrae.
This article summarizes official overseas sources and published studies as general information. It is not medical advice. Please discuss treatment choices with the doctors who examine you.
Sources (checked November 2, 2026)
- NICE. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures (TA279). 2013.
- CIRSE. Vertebral augmentation — patient information. Cardiovascular and Interventional Radiological Society of Europe.
- Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408–1416.
- Berenson J, Pflugmacher R, Jarzem P, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer (CAFE). Lancet Oncology. 2011;12(3):225–235.
- Khan OA, Brinjikji W, Kallmes DF. Vertebral augmentation in patients with multiple myeloma: a pooled analysis of published case series. AJNR Am J Neuroradiol. 2014;35(1):207–210.
- Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1–202.
- Kawaguchi Y. Balloon kyphoplasty: surgical results, efficacy and limitations. Spinal Surgery. 2016;30(1):88–92.
- WakeMed Health & Hospitals. Vertebroplasty & kyphoplasty: what to expect.
- The Oncology Nurse / OncLive. Kyphoplasty tops nonsurgical care for spine breaks in cancer patients (CAFE trial report).