Vertebroplasty & Kyphoplasty

Vertebroplasty and kyphoplasty are medical procedures that involve minimal invasion and are utilized for the treatment of spinal fractures and lesions. The primary objective of these techniques is to enhance the strength and stability of the vertebrae.

Physicians from different specialties routinely perform these procedures, and they have proven to be effective in managing conditions such as osteoporotic fractures and spinal metastases.


Vertebral compression fractures (VCFs), which are often associated with osteoporosis and metastatic disease, pose a considerable health risk for elderly individuals. The likelihood of experiencing VCFs rises with age, particularly among women, while men also face increased risk in their 80s.

Various factors, including menopause, immobilization, steroid therapy, and specific medical conditions, contribute to the development of VCFs. Osteoporosis has a notable economic impact, with estimated costs in the United States amounting to millions of dollars. As the population continues to age, it is anticipated that the prevalence and economic burden of this condition will further escalate.

Millions of Americans are impacted by osteoporosis, which results in gradual bone loss and heightened susceptibility to vertebral compression fractures. These fractures are associated with intense and persistent pain, which may contribute to dependence on narcotics.

Elderly individuals are especially susceptible and may face chronic pain, sleep disturbances, depression, limited mobility, and a loss of independence as a result. Furthermore, compression fractures in the thoracic and lumbar regions can adversely affect lung capacity.

Initially designed for painful vertebral body hemangiomas, vertebroplasty and kyphoplasty have now been extended to address osteoporotic compression fractures and metastatic spinal lesions. Metastatic disease frequently affects the spine, resulting in weakness, fractures, pain, deformity, and neurological impairments.

Breast, lung, and prostate cancers are the primary sources of metastases. These conditions have a significant impact on patients’ quality of life. Vertebroplasty is employed to alleviate symptoms in spinal metastatic disease, multiple myeloma, malignant compression fractures with epidural involvement, and in conjunction with radiotherapy.

Natural History and Conservative Management

VCFs caused by osteoporosis can lead to a cycle of recurring fractures. Research revealed that individuals with low bone mass density or multiple VCFs are at a considerably higher risk of experiencing future fractures. Fortunately, management approaches result in improvement for approximately two-thirds of patients with acute symptomatic fractures.

The conventional conservative approach for treating vertebral compression fractures (VCFs) includes pain medication and bedrest, but this method has limitations. Physical therapy and bracing offer alternative options to mitigate adverse effects.

Multiple medical treatments have yielded inconclusive outcomes. However, a study indicated that vertebroplasty, when compared to medical treatment alone, effectively alleviates pain and enhances physical activity, establishing it as a viable choice for VCFs.

Assessment and Patient Selection

Prior to initiating a spinal procedure, it is essential to conduct a thorough examination of the nervous system to evaluate any potential motor or sensory alterations. Before the procedure, routine blood work, coagulation studies, and relevant investigations for suspected malignancies should be conducted.

Radiological evaluations encompass spinal X-rays, CT scans to assess the structural integrity of the posterior cortex, and MRI scans to examine the degree of cord compression and identify prognostic factors such as the presence of bone marrow or endplate edema. Signal alterations observed on MRI scans, along with substantial collapse of the vertebral body, are indicative of positive outcomes in the treatment process.

Vertebroplasty is primarily employed when conservative approaches fail to alleviate severe pain resulting from vertebral fractures. Typically, patients considered for vertebroplasty have endured pain for more than 6 weeks but less than 1 year, although successful treatment of fractures up to 2 years old has been reported.

Guidelines assist in selecting appropriate candidates, with painful osteoporotic and osteolytic fractures being common indications. Contraindications include severe wedge deformity, significant loss of vertebral height, burst fractures, notable compromise of the spinal canal, myelopathy, and other factors.

The use of vertebroplasty as a preventive measure is subject to debate, but it is generally reserved for patients experiencing symptomatic discomfort. In case of cement extravasation leading to myelopathy, emergency decompressive surgery should be readily available.

Kyphoplasty, which emerged in the late 1990s, is an adapted method that restores vertebral body height and enables the introduction of cement into a cavity with reduced pressure.

The utilization of a balloon mitigates the risk of cement leakage and has demonstrated a decreased occurrence of end plate fractures. The indications for kyphoplasty resemble those of vertebroplasty, although the effectiveness can be influenced by the age of the fracture. To perform the procedure, a minimum remaining vertebral height of 8 mm is necessary.

Vertebroplasty Technique

Once medical clearance and informed consent are obtained, the patient is transported to the interventional radiology suite. Typically, a surgeon and a radiologist are present during the procedure, although some centers may have a single operator.

The patient is positioned in a prone position with comfortable padding and their arms elevated above the head. Mild sedation and pain relief may be administered, and vital signs are continuously monitored. To minimize the risk of infection, the targeted area is meticulously prepared and draped in a sterile manner.

After positioning the patient, the fracture site is identified using biplanar fluoroscopy. CT guidance is seldom necessary, unless there are unique anatomical limitations that make needle placement difficult. A mark is placed on the skin over the designated pedicle, and the area is infiltrated with a buffered anesthetic solution that reaches down to the periosteum.

A variety of needles and cement options are available for percutaneous vertebroplasty, and there is no standardized technique for needle placement. The preferred approach is the parapedicular approach, but the transpedicular approach is also used. Biplanar fluoroscopy confirms the correct trajectory. A small incision is made, and a Jamshidi needle is inserted.

In the transpedicular approach, the needle is advanced to the pedicle, preferably targeting the upper and outer quadrant to avoid nerve root complications. Fluoroscopy guides the needle placement into the vertebral body. The procedure is then repeated for the opposite pedicle.

Using the parapedicular approach in vertebroplasty eliminates the need for bilateral cannulization, thanks to the lateral positioning that enables more precise needle direction. The Jamshidi needle is inserted onto the transverse process and advanced downward, with entry points determined by fluoroscopic images.

Biplanar fluoroscopy ensures accurate needle alignment with the vertebral body. While the parapedicular approach carries a theoretical risk of pneumothorax and bleeding, our experience suggests that complication rates are comparable to those of the transpedicular approach.

Regardless of the approach employed, it is essential to position the needle tip in the anterior half of the vertebral body on lateral views and in the medial third on AP views. To reduce radiation exposure to the operator’s hand, a clamp can be utilized to stabilize the needle during imaging. When treating multiple vertebral levels, it is preferable to cannulate all the levels before initiating cement injection.

Although some centers previously recommended intraosseous venography, it has been determined that it does not provide additional safety benefits during cement injection. Consequently, we have discontinued the routine use of venography before the procedure. To prevent the introduction of air, the needle is filled with sterile saline once proper placement has been confirmed.

A variety of cement products are available for vertebroplasty, and the selection depends on the practitioner’s expertise. Polymethylmethacrylate (PMMA) is a commonly used cement that combines a powder and liquid to form a solid compound.

The injection is performed when the PMMA reaches a toothpaste-like consistency. Radiopaque markers are used to assist with visualization during the injection process. Typically, 5 to 10 cc of PMMA is injected into each treated vertebral body. If cement leakage occurs, the injection should be halted.

The optimal volume of cement needed for pain relief and the exact mechanism behind its effectiveness are still not fully understood, but it is believed to involve mechanical stabilization and neural thermal necrosis.

After completing the injection, the needle is removed and minor bleeding is controlled. Patients rest for 2 hours before sitting and walking with assistance. A postoperative CT scan is obtained to assess vertebral body filling and rule out spinal cord compression. Patients are discharged on the same day with NSAIDs and muscle relaxants, encouraged to be active in daily life.

Vertebroplasty Technique

Kyphoplasty involves the use of an inflatable bone tamp or balloon to restore the height of the vertebral body, creating a cavity that can be filled with cement. However, it is important to note that restoring vertebral body height does not necessarily result in pain relief or improved quality of life. Radiographic images are used with contrast medium to confirm the expansion of the vertebral body.

In kyphoplasty, a bone tamp is inserted using either a transpedicular or parapedicular approach. The tamp is inflated to create a cavity, and then PMMA cement is injected into the cavity until it reaches two-thirds of the way to the posterior cortex of the vertebral body.


Vertebroplasty demonstrates a 90% to 95% success rate in pain reduction for osteoporotic fractures, enhancing mobility and daily activities. Kyphoplasty achieves an average restoration of 47% of lost vertebral body height, providing pain relief and improved function for osteoporotic fractures. However, the lack of comparative studies and reliance on retrospective and observational data limit conclusive evidence.

Percutaneous vertebroplasty and kyphoplasty offer effective and minimally invasive options for managing osteoporotic and osteolytic vertebral compression fractures. These procedures provide pain relief and improved quality of life in selected patients, with proper technique and patient selection minimizing complications. Further research is needed to compare different approaches and assess cost-effectiveness.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.