What Is Percutaneous Vertebroplasty?

Percutaneous vertebroplasty is a minimally invasive surgery that has often been used to treat compression fractures. In an effort to stabilize crushed vertebrae, cement (made from acrylic) is injected into the vertebra.

Based on randomized and observational studies, vertebroplasty was thought to be effective in relieving pain. The rationale for pain relief was thought to be added mechanical support provided to the spine.

Cementing the bone is meant to provide more stability. More recently, however, two well-designed studies have cast doubt on the ability of these procedures to actually result in pain relief, when compared to a sham procedure (more on that in a bit).

Does Vertebroplasty Work?

Prior to the more recent data, a previous review of all the available medical literature on vertebroplasty and kyphoplasty performed on patients over 30 years concluded that vertebroplasty could provide pain relief within the first two weeks after the procedure, though long-term benefits seemed to be lacking.

Many have postulated that such pain relief from vertebroplasty was due to the stability restored to the bone when the cement is injected. But two small well-designed studies done in 2009 and published in the New England Journal of Medicine found the placebo (also called the sham treatment) that was given to half of the study participants worked just as well as the vertebroplasty.

In the studies, the sham treatment consisted of an injection of a pain reliever into the outer covering of the bone, where there are nerves that can transmit pain signals. Because both the sham treatment and the vertebroplasty groups got approximately the same amount of relief, some experts are beginning to wonder if merely injecting an analgesic into the spine might do just as well.

With only a few well-designed studies on vertebroplasty for spinal fracture available, researchers are hard pressed to paint an accurate picture in response to this consideration.

Vertebroplasty is big business. In a New England Journal of Medicine editorial about the two studies, Dr. James Weinstein DO, and Chair of the Department of Orthopaedic Surgery at Dartmouth-Hitchcock Medical Center estimates that the number of procedures given in the last 6 years has doubled. Yet, there are numerous unanswered questions about how it really works. As of 2009, many more high quality research studies will need to be done before we can know for certain if vertebroplasty is the best way to relieve pain due to spinal fracture.


McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL.Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J. 2009 Jun;9.

James N. Weinstein, D.O., M.S. Balancing Science and Informed Choice in Decisions about Vertebroplasty.

New England Journal of Medicine. August 6, 2009.

Rachelle Buchbinder, Ph.D., et al. A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures. New England Journal of Medicine. August 6, 2009.

David F. Kallmes, M.D., et al. A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures. New England Journal of Medicine. August 6, 2009.

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