Kyphoplasty vs. Vertebroplasty: What's the Difference?

Medically reviewed by Dr. David L. Greenwald, MD, FAANS, FACS — dual board-certified spine surgeon & neurosurgeon. Last reviewed October 2026.

Kyphoplasty and vertebroplasty are two minimally invasive procedures that treat the same problem: a painful vertebral compression fracture, usually caused by osteoporosis. Both work by injecting medical bone cement into the broken vertebra through a needle, which hardens in minutes and stops the painful micro-motion of the fracture. The difference comes down to a single extra step. Kyphoplasty inflates a small balloon inside the vertebra first, to carve out a cavity and lift the collapsed bone back toward its original height, then fills that space with cement. Vertebroplasty skips the balloon and injects the cement directly. That one distinction shapes everything else that follows, including which fractures each suits best, what the cement does, and the small differences in risk. This guide explains how each procedure works, what the research actually shows, and how a spine surgeon chooses between them.

What's in This Guide

Kyphoplasty vs. Vertebroplasty at a Glance

The Problem Both Fix: Vertebral Compression Fractures

To understand the two procedures, it helps to picture what they are repairing. A vertebral compression fracture happens when the front of a vertebra, the block-shaped bone that stacks to form the spine, collapses under load. In healthy bone this takes major trauma. In bone thinned by osteoporosis it can happen with something as small as a cough, a sneeze, a misstep, or lifting a grocery bag. The vertebra wedges forward into a slightly flattened shape, which can cause sudden, sharp back pain and, over time, a stooped posture.

These fractures are far more common than most people realize, and many are never diagnosed because the pain is mistaken for an ordinary backache.

Most compression fractures heal on their own with time, activity modification, pain control, and treatment of the underlying osteoporosis. Kyphoplasty and vertebroplasty are considered when the pain is severe and disabling, when it is not settling with conservative care, or when imaging shows a fresh, unhealed fracture driving the pain. They are not used for a fracture that is not causing symptoms. You can read more about the broader category of these injuries on the spinal conditions overview, and about non-surgical options on the conservative care page.

Source: American Family Physician: Vertebral Compression Fractures in the Elderly | Mayo Clinic: Osteoporosis

What Is Vertebroplasty?

Vertebroplasty was the first of the two procedures, introduced in the 1980s. It is elegantly simple. With the patient positioned face down and the area numbed, usually with light sedation, the physician uses live X-ray guidance (fluoroscopy) to pass a thin needle through a small puncture in the skin, through the pedicle (a bony bridge on the back of the vertebra), and into the fractured vertebral body. Medical-grade bone cement, polymethylmethacrylate or PMMA, is then injected directly into the broken bone, where it spreads through the cracks and spaces and hardens within minutes.

That hardened cement acts like an internal cast. It stops the tiny painful movements at the fracture and bears load so the fragile bone does not have to. Many patients feel relief quickly, often within a day. There is no balloon and no attempt to change the vertebra's shape. The goal is to stabilize the fracture where it sits. Because it is the simpler of the two, vertebroplasty is generally faster and less expensive. The tradeoff is that cement is injected at higher pressure into bone that has no prepared cavity, which is the main reason it carries a somewhat higher reported rate of cement escaping the vertebra. Desert Spine and Pain details the procedure on its vertebroplasty treatment page.

Source: Balloon kyphoplasty vs. percutaneous vertebroplasty for osteoporotic vertebral compression fracture: meta-analysis, Journal of Orthopaedic Surgery and Research (2018)

What Is Kyphoplasty?

Kyphoplasty, more precisely balloon kyphoplasty, starts exactly the same way: face down, numbed, a thin needle guided into the fractured vertebra under fluoroscopy. Then it adds the step that defines it. Before any cement goes in, a small balloon (called a bone tamp) is threaded through the needle into the vertebra and gently inflated. The inflating balloon does two things at once. It pushes the collapsed end plates apart, lifting the vertebra back toward its normal height and reducing the forward wedge angle, and it carves out a clean cavity in the soft fractured bone.

The balloon is then deflated and removed, leaving a hollow space. Cement is placed into that prepared cavity at lower pressure, where it fills the void and locks in the regained height as it hardens. The name captures the intent: kypho refers to kyphosis, the forward curve that a wedged vertebra creates, and the procedure is designed to counter it. The extra step means a slightly longer, more involved, and more costly procedure, but it buys two things vertebroplasty does not target: height restoration and a controlled, lower-pressure cement fill. The full procedure is described on the balloon kyphoplasty treatment page, and we cover it in depth in our full explainer on what kyphoplasty is.

Source: Journal of Orthopaedic Surgery and Research (2018) meta-analysis | Mayo Clinic: Osteoporosis and fragility fractures

The Core Difference: The Balloon

Strip away the terminology and the whole comparison comes down to one question: does the procedure try to put the vertebra back into shape before stabilizing it, or does it stabilize it as is? Kyphoplasty uses a balloon to recover height and make a cavity. Vertebroplasty does not. Everything else, including the differences in leakage, height, and cost, flows directly from that one choice.

The balloon matters most when a fracture is fresh and the collapse is recent, because newly broken bone can still be lifted. In an older fracture that has already begun to heal in a wedged position, the balloon has far less to work with, and the height advantage shrinks. This is a big reason the decision is driven by the specific fracture rather than a blanket rule. Lowering the pressure needed to place the cement, because it flows into an open cavity rather than being forced through intact fractured bone, is also what gives kyphoplasty its edge on containing cement.

Head-to-Head: How Kyphoplasty and Vertebroplasty Compare

When both procedures could technically treat the same osteoporotic compression fracture, these are the criteria that actually separate them. The strongest evidence comes from a 2018 systematic review and meta-analysis that pooled 16 studies comparing balloon kyphoplasty with percutaneous vertebroplasty.

Pain Relief and Function

This is the headline finding, and it surprises people: the two procedures relieve pain and restore function about equally. The 2018 meta-analysis found no significant difference in pain scores on the visual analog scale (VAS) or in disability on the Oswestry Disability Index (ODI) between the groups. In plain terms, a patient is not likely to hurt less or move better just because they had one procedure rather than the other.

Height and Spinal Alignment

Here kyphoplasty pulls ahead by design. Because the balloon lifts the collapsed bone before the cement sets, kyphoplasty restored more vertebral body height and produced a greater reduction in the kyphotic wedge angle than vertebroplasty in the pooled data. For a patient with a fresh, significantly wedged fracture, that structural correction can matter for posture and for how load is shared across the spine, though whether it changes long-term outcomes is still debated.

Cement Leakage

Cement leakage means some cement escapes the boundary of the vertebra during injection. It is the most-discussed difference between the procedures. Because kyphoplasty places cement into a prepared cavity at lower pressure, it leaks less often. The 2018 meta-analysis found kyphoplasty carried roughly 38% lower odds of leakage.

The important context: the large majority of cement leaks cause no symptoms at all. Most are tiny, found only on imaging, and never noticed by the patient. Serious problems from leakage, such as cement pressing on a nerve or traveling to the lungs, are rare. A single-center study of 896 kyphoplasty patients put the point in numbers.

Source: Journal of Orthopaedic Surgery and Research (2018) meta-analysis | Incidence of symptomatic bone cement displacement after kyphoplasty, single-center study of 896 patients (PMC)

Speed, Complexity, and Cost

Vertebroplasty has fewer moving parts. No balloon, no cavity creation, fewer instruments, and usually a shorter procedure, which generally translates to lower cost. Kyphoplasty's extra step adds time and expense, and the balloon and related hardware are not free. For a patient or payer weighing value, vertebroplasty is the leaner option when height restoration is not the goal.

Recovery

Recovery is similar for both. Each is minimally invasive and typically done as an outpatient through a needle puncture rather than an incision, so there is no surgical wound to heal. Many patients experience significant pain relief within the first day or two and go home the same day, then return to normal activity over the following days to weeks as guided by their physician. Both are, in the broader picture, part of a minimally invasive approach to spine care.

Kyphoplasty vs. Vertebroplasty: Full Comparison

What the Research Actually Says

An honest comparison has to address a real controversy in this field, because patients researching these procedures will run into it. Cement augmentation for compression fractures has been studied hard, and the results have been genuinely mixed, which is why guidance has shifted over the years.

In 2009, two influential masked, placebo-controlled trials published in the New England Journal of Medicine (Buchbinder and colleagues, and the INVEST trial by Kallmes and colleagues) found that vertebroplasty was no more effective than a sham procedure for pain. Those results prompted real caution about whether the cement itself was doing the work.

Later trials that enrolled patients differently told a different story. The VAPOUR trial, published in The Lancet in 2016, studied patients with acute fractures of less than six weeks and severe pain, used a truer placebo, and found vertebroplasty did outperform the sham procedure. Other trials, such as VERTOS IV, again found no significant advantage over sham. The through-line most experts draw is that patient selection is everything: these procedures appear to help most when the fracture is fresh, confirmed on MRI, and causing severe pain, and help least when it is older or only mildly symptomatic.

Source: Buchbinder et al., randomized trial of vertebroplasty, NEJM (2009) | Kallmes et al., INVEST trial, NEJM (2009) | Clark et al., VAPOUR trial, The Lancet (2016)

Who Is a Candidate, and How a Surgeon Chooses

Neither procedure is a first move. Most compression fractures are given a chance to heal with conservative care first. Cement augmentation enters the conversation when specific conditions line up.

You are more likely to be a candidate for either procedure if:

• You have a painful vertebral compression fracture confirmed on imaging, ideally a fresh or unhealed fracture shown active on MRI.
• The pain is severe and disabling, and it has not improved with a reasonable course of conservative care (rest, activity modification, pain medication, bracing).
• The fracture is from osteoporosis, a benign lesion, or certain spinal tumors rather than a stable, painless old fracture.
• You do not have an active infection, a bleeding disorder, or an asymptomatic fracture, each of which is a reason not to proceed.

Once augmentation is the plan, the choice between the two is a technical, fracture-specific judgment:

• Kyphoplasty is favored when the fracture is fresh and significantly wedged, so recovering height and correcting the forward angle is worthwhile, or when minimizing cement leakage is a particular priority.
• Vertebroplasty is reasonable when the goal is only to stabilize a painful fracture, height loss is minor or already fixed, and a faster, lower-cost procedure is preferred.

This is a decision best made by a surgeon who performs both and who starts with the least invasive effective option. You can compare a related operation in kyphoplasty versus corpectomy, a far larger reconstruction reserved for very different fractures.

Explore vertebral compression fracture repair

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Source: American Family Physician: Vertebral Compression Fractures in the Elderly | Journal of Orthopaedic Surgery and Research (2018) meta-analysis

The Verdict: Which Is Better?

There is no single winner, and any article that crowns one is oversimplifying. For the outcomes that matter most to patients, pain relief and getting back to normal life, the two procedures perform about the same. Where they differ is structure and safety margin: kyphoplasty restores more height, corrects the wedge angle better, and leaks less cement, which genuinely counts for a fresh, significantly collapsed fracture. Vertebroplasty answers back with speed, simplicity, and lower cost when the aim is purely to stabilize a painful break.

The real decision is made at the MRI, by matching the procedure to the specific fracture and, before that, by confirming the fracture should be treated with cement at all. That is a judgment best made by a spine specialist who performs both, who treats surgery as a last resort rather than a first option, and who will tell you honestly when watchful waiting is the smarter path.

Desert Spine and Pain is a Phoenix, Arizona practice led by Dr. David L. Greenwald, MD, FACS, a board-certified surgeon who is both a spine surgeon and a neurosurgeon. Patients travel from across the Greater Phoenix area and beyond for this level of care, and every plan starts with a careful look at whether a procedure is needed at all.

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Common Questions About Kyphoplasty and Vertebroplasty

Sources and Methodology