Spinal Compression Fracture Surgery

Most spinal compression fractures heal without an operation. Cement or screws are for the fractures that do not.

A spinal compression fracture happens when the front of a vertebra collapses, usually in bone thinned by osteoporosis, sometimes after a fall that seemed minor or a simple lift. Many heal with pain relief and time. For pain that does not settle, surgeons inject bone cement into the broken vertebra through a needle, with or without first restoring its height with a small balloon, and an unstable fracture may need screws. This page explains which fractures benefit, what the sham-controlled trials found, how vertebroplasty and kyphoplasty compare, what to do about the bones afterward, and what to send for a free review of your MRI.

Why the vertebra collapses

Three causes account for nearly all compression fractures. Each leads to a different plan.

Osteoporosis

Thinned bone gives way under ordinary loads. The fracture follows a cough, a lift or a minor fall, and sometimes nothing the patient can recall at all, which leaves many people treating a sore back for weeks before anyone orders a scan. An MRI with a fluid-sensitive sequence shows whether a fracture is fresh, because a healing vertebra carries swelling inside the bone that an old collapse does not.

Cancer, injury and unstable fractures

Myeloma and cancer that has spread to the spine weaken a vertebra from inside, and a car accident or a fall from height can break a healthy one. Some of these fractures stay stable and are treated much like an osteoporotic collapse, with cement where the pain demands it. Others do not. A burst fracture that pushes bone into the spinal canal, a fracture with nerve symptoms, or a collapse that keeps progressing into a forward stoop needs open surgery, in which the surgeon frees the nerves and fixes the vertebrae above and below with screws and rods, with cement around the screws to hold them in soft bone. That operation means six to seven nights in hospital in published packages. Recovery is measured in months rather than days, the first weeks are spent walking short distances several times a day with a physiotherapist, and the flight home waits until the wound is checked and the standing X-ray confirms that the screws sit where they were placed. For a patient traveling from abroad, that difference in time away from home shapes the whole plan, so the first question in every review is whether the fracture is stable.

When a compression fracture is an emergency

• New weakness or numbness in the legs
• Trouble passing urine or controlling the bowels
• Fever together with back pain
• A fracture after a car accident or a fall from height

Cement or conservative care

Pain relief, a short rest, gentle walking and sometimes a brace let many osteoporotic fractures heal within weeks. Cement injection, called vertebroplasty, has been tested against that care and against a sham procedure, in which patients lie on the table and receive local anesthetic without the cement.

Cement helps most when the fracture is fresh, the pain is severe and the MRI shows swelling in the bone.

Across 20 randomized trials and 2,566 patients, cement relieved pain better than conservative care at every time point. Against a sham procedure, the difference was not significant at most time points. The patients who still gain are those treated within six weeks of the fracture.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

So the decision rests on three findings that any surgeon can read from your file, which are the age of the fracture, the swelling inside the bone on a fluid-sensitive MRI sequence, and how much the pain still limits standing and walking after a few weeks of ordinary care. The table below sets out how those findings translate into a plan.

On a phone, slide this table sideways to read all of its columns.

Vertebroplasty and kyphoplasty compared

Both procedures go through the skin of the back under X-ray guidance, through openings smaller than a centimeter. Nothing stays behind but cement. A meta-analysis of comparative studies found less cement leakage and better restored height after kyphoplasty, with no difference in pain, disability or new fractures at neighboring levels, while kyphoplasty took longer and cost more. For most patients the choice comes down to the shape of the broken vertebra, and the surgeon explains it on the images.

Drag sideways on a narrow screen to see the whole table.

How each procedure works

Vertebroplasty

The needle enters the broken vertebra on one or both sides. Liquid cement fills the cracks and sets within minutes. Walking starts the same day.

Kyphoplasty

In kyphoplasty, a small balloon is inflated inside the vertebra first, to lift the collapsed bone and leave a cavity, and the cement then fills that cavity at lower pressure.

New fractures and cement leakage

Two worries come up at almost every consultation.

Does cement cause the next fracture

Fourteen randomized trials with 1,413 patients, pooled together, found no increase in new vertebral fractures after vertebroplasty compared with control treatment, with a risk ratio of 1.05, and fewer serious adverse events, with a risk ratio of 0.53. Treatment within six weeks of the fracture was linked to fewer new fractures.

The next fracture comes mostly from the osteoporosis itself.

Cement leakage

Small amounts of cement can seep into the veins or the disc next to the vertebra. Most of these leaks cause no symptoms. Leakage still matters. Across 15 studies and 6,546 patients, it raised the odds of a new fracture 3.4 times, more than older age, female sex or the number of treated levels, so slow injection under continuous X-ray counts for more than the brand of cement. In cancer-related fractures, where most of seven randomized trials showed better pain relief than other treatments, leakage appeared in a quarter of procedures.

Treating the bones as well as the fracture

A vertebral fracture from a minor strain means osteoporosis until proven otherwise. The risk of another fracture peaks in the first year, so the bone plan starts during the same visit.

The stay and the flight home

One published kyphoplasty package in Istanbul lists three to four days in hospital, and six to seven when screws are added. Plan five to seven days in Istanbul after cement alone and two weeks after open fixation.

1. Day one, MRI, standing X-rays and a review with the surgeon
2. Day two, the procedure under local or general anesthesia, and walking the same evening
3. Days three to four, discharge once walking is comfortable
4. Before the flight, a check of the needle sites and the written bone plan
5. At home, a daily walk and no heavy lifting for six weeks

Many patients notice less pain within a day or two. Some feel it at once. Long flights raise the risk of clots, so walk the aisle every hour. Your coordinator is assigned from the first message. That person keeps the same WhatsApp number after you return home, answers in English, Arabic, French, Russian, Serbian, Romanian or Spanish, brings in an interpreter for any other language, and stays the single contact for the surgeon, the ward and the hotel from the first scan you send until the last check of the needle sites before your flight. One relative can sleep on a companion bed in the patient room. Hotel nights before and after the admission, airport transfers and every ride to the hospital are booked by the international patients office, so nobody in the family has to find a taxi with a sore back to look after. Meals from the hospital kitchen come halal, vegetarian or diabetic. There is a prayer room on site. Female surgeons can be requested and are assigned wherever the rota allows, and the invitation letter for the visa leaves ten days before travel.

What a quote should cover

Cost depends on the number of levels, on balloon kyphoplasty against simple vertebroplasty, and above all on whether screws are needed. The published package for this market includes the procedure, an MRI with a fluid-sensitive sequence, standing X-rays, a posture assessment, a rheumatology consultation and airport transfers. Flights, the hotel and screw fixation are extra.

Spinal compression fracture surgery FAQ

References

1. Li WS, Cai YF, Cong L. The effect of vertebral augmentation procedure on painful OVCFs: a meta-analysis of randomized controlled trials. Global Spine J. 2022;12(3):515-525.
2. Lainez Ramos-Bossini AJ, Lopez Zuniga D, Ruiz Santiago F. Percutaneous vertebroplasty versus conservative treatment and placebo in osteoporotic vertebral fractures: meta-analysis and critical review of the literature. Eur Radiol. 2021;31(11):8542-8553.
3. Manchikanti L, Sanapati J, Pampati V, et al. Utilization of vertebral augmentation procedures in the USA: a comparative analysis in Medicare fee-for-service population pre- and post-2009 trials. Curr Pain Headache Rep. 2020;24(5):22.
4. Daher M, Kreichati G, Kharrat K, Sebaaly A. Vertebroplasty versus kyphoplasty in the treatment of osteoporotic vertebral compression fractures: a meta-analysis. World Neurosurg. 2023;171:65-71.
5. Lainez Ramos-Bossini AJ, Jimenez Gutierrez PM, Moraleda Cabrera B, et al. Risk of new vertebral compression fractures and serious adverse effects after vertebroplasty: a systematic, critical review and meta-analysis of randomized controlled trials. Quant Imaging Med Surg. 2024;14(11):7848-7861.
6. Lian YS, Chen LP, Chen JY. Risk factors for new vertebral fracture after percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J. 2025;34(11):5116-5125.
7. Mattie R, Brar N, Tram JT, et al. Vertebral augmentation of cancer-related spinal compression fractures: a systematic review and meta-analysis. Spine. 2021;46(24):1729-1737.