Indications
- Osteoporotic VCF — acute/subacute, refractory to medical therapy
- Pathologic fracture — metastatic disease, myeloma
- Genant Grade 1–3 — mild, moderate, severe compression
- MRI bone marrow edema — confirms acuity, predicts response
- Failure of conservative care — 4–6 weeks of pain management
- Intravertebral cleft — vacuum phenomenon, excellent response
- Osteonecrosis (Kümmell disease) — delayed VCF complication
- Sacroplasty — sacral insufficiency fracture variant
Vertebroplasty vs Kyphoplasty
- Vertebroplasty — direct cement injection, no height restoration
- Kyphoplasty — balloon inflation first, cavity, then cement
- Kyphoplasty — partial height restoration possible, lower leak rate
- Cement — PMMA (polymethylmethacrylate), radiopaque
- Consistency — thick toothpaste for VTP, slightly thinner for KP
- Bipedicular approach — most thoracolumbar, single for cervical
- Cement volume — 2–4 mL per vertebral body (lumbar)
- Fluoroscopic monitoring — inject slowly, watch for leakage
Full Vertebroplasty & Kyphoplasty Playbook
Needle placement, cement preparation, leak management, and post-procedure care
Cement Leakage and Complications
- Epidural leak — stop injection, monitor neurologic status
- Foraminal leak — radiculopathy, may require decompression
- Venous leak — pulmonary cement embolism risk
- Disc space leak — accelerated adjacent disc degeneration
- Pulmonary cement embolism — rare, usually asymptomatic
- Adjacent level fracture — new fracture after augmentation
- Infection — rare, risk increased with myeloma patients
- Posterior cortex breach — contraindication to cement injection