Vertebroplasty & Kyphoplasty for Spinal Fracture in Delhi

A vertebral compression fracture is a collapse of one of the bones of the spine. In older adults with osteoporosis it can happen with very little force — a stumble, lifting something awkwardly, a heavy cough, or sometimes nothing identifiable at all.

Vertebroplasty and balloon kyphoplasty are procedures in which surgical cement is injected through a needle into the collapsed bone to stabilise it. This page explains them, and it also explains honestly why the evidence for them is genuinely disputed — because you should know that before agreeing to one.

The usual presentation is sudden, severe back pain at one spot, much worse on moving, standing or turning over in bed, and eased by lying still. Over time repeated fractures cause loss of height and a forward stoop.

An X-ray shows the collapse. An MRI is what tells us whether it is recent — fresh fractures show marrow oedema, older healed ones do not. That distinction is central to everything below, because it determines whether a procedure could help at all.

Two things need excluding before anything else: that the fracture is not caused by a tumour or infection rather than osteoporosis, and that there is no compression of the spinal cord or nerves. Both change the plan entirely, and a suspected tumour or spinal cord compression needs urgent referral to a tertiary centre.

This is the part that is often skipped. Most osteoporotic compression fractures settle over roughly six to twelve weeks with:

• Adequate pain relief — enough to let you keep moving, which prevents the muscle loss and pneumonia risk that come with lying still
• Early mobilisation, with physiotherapy support
• A brace in some cases, for comfort rather than as a cure
• And critically, treatment of the osteoporosis itself

Pain that is improving week by week is usually pain that will continue to improve. A procedure is considered when it is not.

Under X-ray guidance and local anaesthetic with sedation, a needle is passed through the back into the collapsed vertebra and bone cement is injected. The cement hardens within minutes, stabilising the fractured bone.

The same approach, with an additional step: a small balloon is inflated inside the vertebra first to create a cavity and partially restore the collapsed height, then withdrawn before the cement is placed. It allows cement to be injected at lower pressure, which may reduce leakage, and can recover some lost height.

Both are day-care or overnight procedures in most cases. Neither treats the osteoporosis that caused the fracture.

We think you are entitled to the real picture rather than a confident one.

Several trials have compared vertebroplasty against a sham procedure — patients had a needle placed and went through the whole experience without cement being injected. Three of four such trials found no meaningful benefit from the cement. One of those trials specifically studied acute fractures, which had been the main argument for the procedure, and was also negative.

One trial did find a benefit, in a narrower group: patients with severe pain from a recent fracture, ill enough to be in hospital because of it.

Expert guidance is split as a result. Some national bodies support it as an option in selected patients; others conclude the evidence does not support routine use, at the highest level of evidence grading. That disagreement is real and unresolved, not a matter of one side being behind the times.

What that means in practice at Sama. We do not offer this as a routine treatment for a painful spinal fracture. We consider it in the specific situation where the evidence is least unfavourable: a fracture confirmed as recent on MRI, at a level that matches where your pain is, with severe pain that is not being controlled by proper medical treatment, in a patient whose function is being seriously limited by it.

If you do not fit that picture, we will say so and treat you without it. And if you have been told elsewhere that cement injection is the obvious answer for any spinal fracture, that is worth questioning.

This deserves emphasis, because it is where the real long-term benefit lies and it is routinely neglected.

A vertebral fracture from minor force is a diagnosis of osteoporosis, and it substantially raises the risk of the next fracture — in the spine and at the hip. Cement stabilises one bone. It does nothing for the other twenty-three vertebrae or for your hips.

So every patient we see with one of these fractures gets an osteoporosis assessment: bone density measurement, checks for vitamin D deficiency and other treatable contributors, a review of medications that weaken bone, a falls assessment, and treatment to reduce future fracture risk.

We would not perform a cement procedure without that pathway in place. Doing the procedure and ignoring the osteoporosis treats the symptom and leaves the disease.

• Cement leakage outside the vertebra — common on imaging, usually causing no symptoms, but occasionally pressing on a nerve or the spinal cord and requiring further surgery
• Cement embolism — cement entering a vein and travelling to the lungs; rare
• Infection and bleeding
• Nerve injury from needle placement
• Rib or other fracture from positioning in fragile bone
• No benefit — which, given the trial evidence above, is a genuine possibility and not a formality

Whether fractures at adjacent levels become more likely afterwards has been debated; randomised evidence does not clearly support an increase, though it is often quoted as a risk.

Does a spinal compression fracture need surgery?

Usually not. Most osteoporotic compression fractures settle over about six to twelve weeks with adequate pain relief, early movement, physiotherapy and treatment of the osteoporosis itself. A cement procedure is considered only where severe pain from a recent fracture is not responding to proper medical treatment and is seriously limiting function.

Does vertebroplasty actually work?

The evidence is genuinely disputed, and we would rather say so. Three of four trials comparing vertebroplasty against a sham procedure — where patients underwent everything except the cement injection — found no meaningful benefit. One trial did find benefit, in patients with severe pain from a recent fracture who were unwell enough to be in hospital. National guidance is split as a result. We consider the procedure only in that narrow group where the evidence is least unfavourable.

What is the difference between vertebroplasty and kyphoplasty?

Vertebroplasty injects cement directly into the collapsed vertebra. Kyphoplasty adds a step: a small balloon is inflated inside the bone first to create a cavity and partially restore lost height, then removed before the cement is placed. This allows cement to be injected at lower pressure, which may reduce leakage. Both are performed through a needle under X-ray guidance.

Why does an MRI matter before the procedure?

Because it shows whether the fracture is recent. Fresh fractures show marrow oedema on MRI; older healed ones do not, and injecting cement into a healed fracture will not relieve pain. The MRI also helps exclude a tumour or infection as the cause, and confirms that the painful level matches the fracture seen. We would not perform the procedure without that confirmation.

Will I get more fractures after this?

A vertebral fracture from minor force is itself a diagnosis of osteoporosis and substantially raises the risk of further fractures in the spine and at the hip. Cement stabilises one bone and does nothing for the rest. That is why osteoporosis assessment and treatment — bone density measurement, vitamin D, medication review, falls assessment and treatment to reduce fracture risk — matters more for your long-term outcome than the procedure itself.

Vertebral compression fractures are assessed by Dr. Om Prakash Gupta, Senior Consultant Orthopaedic & Endoscopic Spine Surgeon, as part of Sama’s Minimally Invasive & Endoscopic Spine Surgery service, alongside osteoporosis assessment.

Sama Hospital, 8 Siri Fort Road, Sadiq Nagar, New Delhi 110049. 24/7 emergency; specialist OPD during daytime hours. For an estimate of cost, call us — please bring your X-rays and MRI.