Patients experiencing ongoing pain despite analgesics, rest, and bracing may benefit from vertebral augmentation. These procedures offer an intermediate option between continued conservative care and major spinal surgery.

Recent compression fractures (generally less than 6-8 weeks old) typically respond best to vertebral augmentation. The timing allows intervention before the fracture fully heals in a collapsed position.

The pain pattern should match the anatomical location of the identified fracture. Consistency between symptoms and imaging findings aids in predicting successful outcomes.

Vertebroplasty involves the direct injection of bone cement (typically polymethylmethacrylate or PMMA) into the fractured vertebra. The procedure follows these steps:

• Imaging guidance: Fluoroscopy (real-time X-ray) is used to visualise the vertebra and guide the needle accurately to the fracture site. This continuous imaging allows for precise needle placement and cement delivery.
• Local anaesthesia: The procedure typically requires only local anaesthesia and conscious sedation. The injection site is numbed while the patient remains awake but relaxed during the procedure.
• Cement injection: Bone cement is injected directly into the fractured vertebra. The cement flows into the spaces within the damaged bone and hardens within minutes, providing immediate structural support.

Vertebroplasty aims to stabilise the fracture, prevent further collapse, and provide prompt pain relief. The procedure usually takes less than an hour per treated vertebra and often allows patients to return home the same day.

Kyphoplasty builds upon the vertebroplasty technique by adding a step to create space within the collapsed vertebra.

• Balloon inflation: After needle placement into the vertebra, a special balloon is inserted and inflated. This creates a cavity within the compressed vertebra and can partially restore vertebral height. The balloon expansion helps create a well-defined space for cement placement.
• Controlled cement delivery: After removing the balloon, bone cement is injected into the cavity. The predefined space allows for more controlled cement distribution compared to vertebroplasty. This controlled delivery potentially reduces cement leakage risks.
• Height restoration: Unlike vertebroplasty, kyphoplasty may partially restore vertebral height and reduce kyphotic deformity (forward curvature of the spine). This height restoration can help improve spinal alignment in some patients.

Kyphoplasty typically takes longer than vertebroplasty due to the additional balloon inflation step, but shares similar recovery times and pain relief outcomes.

Cementoplasty refers to bone cement injection into bones other than vertebrae or for conditions beyond simple compression fractures.

• Tumour management: Cementoplasty often treats bone tumours or metastases throughout the skeleton. The cement provides structural support to bones weakened by tumour invasion and may help reduce pain associated with these lesions.
• Preventive application: In some cases, cementoplasty may be performed preventively on bones at high risk of fracture due to significant tumour involvement. This prophylactic approach aims to strengthen compromised bones before fractures occur.
• Combined therapy: Cementoplasty may be combined with tumour ablation techniques (such as radiofrequency ablation) to provide both tumour treatment and structural support in a single procedure. This combined approach addresses both the tumour and its structural consequences.
  While sharing basic principles with vertebroplasty, cementoplasty adapts the technique to different anatomical locations and clinical scenarios.

Most procedures use local anaesthesia with conscious sedation. This approach keeps the patient comfortable while allowing them to respond to questions during the procedure.

Using fluoroscopic guidance, the specialist inserts a needle through the skin into the vertebral body. The transpedicular approach (through the pedicle of the vertebra) or parapedicular approach (alongside the pedicle) provides access to the vertebral body.

Bone cement is prepared and injected. The cement’s consistency and injection timing are carefully controlled to allow proper flow while minimising leakage risks.

Continuous fluoroscopic imaging monitors cement distribution. Real-time monitoring allows immediate detection of potential cement leakage or suboptimal distribution.

The entire procedure typically takes 30-90 minutes, depending on the number of vertebrae treated and whether kyphoplasty is performed.