• Vertebral fracture reduction via bipedicular balloon inflation followed by polymethylmethacrylate (PMMA) cement augmentation


  • Carefully determine correct level

  • STIR MR is most sensitive for vertebral edema

  • Ensure level of pain is consistent with acutely fractured vertebra on imaging


  • Angle C-arm toward side of pedicle to be accessed

    • Must have clear view of pedicle cortex

  • Lateral fluoroscopy is essential in determining needle depth

  • Needle tip in vertebra should allow inflated balloon to be centrally placed in hemivertebra

  • Sudden decrease in pressure and heterogeneous contrast extravasation indicates balloon rupture

Post Procedure

  • Expectation: Significant decrease in pain following procedure

    • Some patients will develop periprocedural pain requiring narcotics ± muscle relaxants

  • Problems: Fracture at additional/adjacent levels

    • Risk appears increased with PMMA cement extravasation into disc space


  • Most feared complications

    • Spinal cord puncture during needle placement

    • Spinal cord compression by hematoma or cement extravasation

Compression Fracture

Balloon Inflation

Cement Injection: AP View

Post Kyphoplasty: Lateral View


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