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Vertebral Compression Fractures: What They Are and How They Happen

A vertebral compression fracture occurs when a vertebral body — the thick, cylindrical bone that forms the front portion of each spinal segment — collapses under load. The thoracic and upper lumbar spine, where compressive forces are concentrated, are the most common sites. In patients with osteoporosis, the bone density loss that characterizes the condition means the vertebral body may fracture under stresses as minor as a cough, a sneeze, or the weight of bending forward.

The signature symptom is a sudden onset of sharp, localized back pain — typically mid-back or upper low-back — that is dramatically worse with standing, walking, and any change in position, and somewhat relieved by lying flat. Many patients describe the pain as the worst they have experienced. Some fractures, however, are nearly painless — discovered incidentally on imaging performed for another reason — while others produce a progressive kyphotic deformity (a forward rounding of the upper back) as the compressed vertebrae lose height.

Camden County patients who present to our Cherry Hill office with this history, particularly those with known osteoporosis or a prior fragility fracture, are evaluated promptly. A current MRI, which distinguishes an acute fracture from an old healed one, is the essential study that guides the treatment decision.

Kyphoplasty vs. Vertebroplasty: Understanding the Difference

Vertebroplasty

Vertebroplasty stabilizes a fractured vertebral body by injecting bone cement (polymethylmethacrylate, or PMMA) directly into the fracture under fluoroscopic guidance. The cement fills the void created by the collapsed bone, hardens quickly, and provides structural stability that eliminates the painful micromotion within the fracture. The procedure is performed through one or two small puncture incisions in the back, typically under conscious sedation, and takes approximately 30 to 45 minutes per level.

Vertebroplasty does not restore lost vertebral height — its goal is stabilization and pain relief, not correction of the collapsed profile.

Kyphoplasty

Kyphoplasty builds on the vertebroplasty concept with an additional step: before cement injection, a specialized balloon is inserted into the fractured vertebral body and inflated to create a cavity and restore some of the lost height. The balloon is then deflated and removed, and cement is injected into the created cavity under lower pressure than standard vertebroplasty.

The height restoration possible with kyphoplasty — particularly in fractures that are acute, where the bone has not yet set in a collapsed position — addresses both pain and the progressive kyphotic deformity that uncorrected compression fractures can produce. It is the preferred approach at our Cherry Hill office for acute fractures with significant height loss. For older fractures where height restoration is no longer feasible, or where anatomical considerations favor direct stabilization, vertebroplasty may be the appropriate choice.

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Who Is a Candidate for Kyphoplasty or Vertebroplasty?

The evaluation at our Cherry Hill office focuses on several key factors in determining candidacy and selecting between procedures:

  • Fracture acuity: MRI signal characteristics distinguish acute from chronic fractures. Acute fractures are the most amenable to kyphoplasty and typically produce the best pain relief. Chronic fractures that have already healed in a collapsed position are less reliably treated.
  • Degree of height loss: Significant height loss in an acute fracture supports kyphoplasty over vertebroplasty, as height restoration remains possible.
  • Posterior wall integrity: Fractures with significant posterior wall involvement require careful evaluation; significant retropulsion of bone into the canal may favor a different surgical approach or change procedural technique.
  • Overall medical status: Both procedures are minimally invasive and well-tolerated, but patients with severe cardiopulmonary compromise or active infection are not candidates.
  • Failed conservative management: Most Cherry Hill patients referred for these procedures have had at least two to four weeks of rest, bracing, and pain medication without adequate relief.

Patients whose fractures are mild, whose pain is manageable, and who are improving on conservative treatment may not need procedural intervention — the fracture will heal naturally over six to twelve weeks. Intervention is appropriate when pain is severe, when conservative care is not working, or when the patient's mobility and independence are being meaningfully compromised.

What to Expect After the Procedure

Kyphoplasty and vertebroplasty are both performed as outpatient procedures at Millennium Surgical Center in Cherry Hill. Patients typically arrive, complete the procedure, and return home within a few hours. General anesthesia or conscious sedation is used depending on the patient's medical history and surgeon preference.

Pain relief following these procedures is often dramatic and rapid — many patients report significant improvement within 24 to 48 hours. The stabilization of the fracture eliminates the micromotion that is the primary source of pain, and the restoration of vertebral height in kyphoplasty addresses the structural source of postural pain.

Most patients return to light activity within a few days. Physical restrictions in the first week or two are minimal — avoiding heavy lifting and significant exertional activity while the operative sites heal. Physical therapy to address core strengthening and functional mobility typically begins within a few weeks. Addressing the underlying osteoporosis — through medical management coordinated with the patient's primary care physician or endocrinologist — is essential to reducing the risk of future fractures.

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Your Surgical Team at POA Cherry Hill

Rahul V. Shah

Dr. Rahul V. Shah, MD, FAAOS

Board-Certified Orthopaedic Spine Surgeon  |  Fellowship-Trained, UCSF  |  Chief Resident, Yale

Dr. Shah evaluates all compression fracture patients at our Cherry Hill office for the appropriateness of procedural intervention — and for those who are candidates, he performs both kyphoplasty and vertebroplasty at Millennium Surgical Center. His UCSF fellowship included subspecialty training in image-guided spinal interventions, and his approach to fracture evaluation is methodical: current MRI, correlation with symptoms and functional status, and a clear explanation of which procedure the clinical picture supports and why.

  • FAAOS — Fellow, American Academy of Orthopaedic Surgeons
  • Spine Surgery Fellowship — University of California, San Francisco
  • Chief Resident — Yale University Orthopaedic Surgery
  • Faculty — Rowan University Medical School

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Joseph R. Zerbo male in white lab coat

Dr. Joseph R. Zerbo, DO

Board-Certified Orthopaedic Spine Surgeon  |  NASS Member  |  35+ Years in Southern NJ

In more than 35 years of spine practice in Camden County, Dr. Zerbo has treated a significant volume of osteoporotic compression fractures in the Cherry Hill patient population. He understands the demographic profile of these patients — typically older, often managing multiple medical conditions — and approaches the procedural evaluation with that full clinical picture in mind. He has performed kyphoplasty and vertebroplasty at Millennium Surgical Center for many years, and patients who have been his patients or whose families he knows come to this intervention with a surgeon who is not a stranger.

  • AOBOS Board-Certified — American Osteopathic Board of Orthopaedic Surgeons
  • NASS Member — North American Spine Society (since 1999)
  • Chief Resident — Kennedy Memorial Hospital / UMDNJ
  • Founder — Zerbo Spine, PA

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Kyphoplasty & Vertebroplasty FAQs

How do I know if I have a vertebral compression fracture?

How quickly will my pain improve after kyphoplasty?

Is there a risk that the fracture will recur after kyphoplasty?

Can both kyphoplasty and vertebroplasty be done at the same time for multiple fractures?

How do I know if I have a vertebral compression fracture?

The most common presentation is sudden, localized back pain in the mid-back or upper low-back that worsens with movement and may improve when lying flat. In patients with known osteoporosis, this pattern after minor physical activity or an otherwise low-impact event should prompt imaging rather than watchful waiting. A plain X-ray can identify vertebral height loss and deformity, while MRI can confirm whether a fracture is acute and help guide treatment decisions.

How quickly will my pain improve after kyphoplasty?

Most patients experience significant pain relief within 24 to 48 hours after the procedure. The cement hardens within minutes, stabilizing the fractured vertebra and reducing the movement-related pain associated with an acute compression fracture. Residual discomfort from the procedure sites typically resolves over the following days.

Is there a risk that the fracture will recur after kyphoplasty?

Once a vertebra has been stabilized with bone cement, recurrent collapse of the treated fracture is generally unlikely. However, patients with osteoporosis remain at elevated risk for new fractures at adjacent or other vertebral levels. Some studies suggest the risk may be higher at levels immediately adjacent to a treated segment, although the mechanism remains debated. Addressing the underlying osteoporosis with appropriate medical therapy is an important part of reducing future fracture risk.

Can both kyphoplasty and vertebroplasty be done at the same time for multiple fractures?

Yes. When a patient has two or more acute fractures that warrant intervention, multiple levels can be treated during the same session. Multi-level treatment adds time to the procedure, and the surgeon will review imaging to determine which fractures are most symptomatic and acute. Treatment is prioritized based on the location and characteristics of each fracture and the patient's overall health.

Premier Orthopaedic Associates Cherry Hill

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1004 Haddonfield Road
Cherry Hill, NJ 08002

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