What are the surgical risks associated with vertebroplasty?

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Last updated: October 28, 2026 • View editorial policy

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Surgical Risks of Vertebroplasty

Vertebroplasty is a relatively safe procedure with major complications occurring in less than 1% of patients treated for osteoporotic compression fractures, though the risk increases to less than 5% in patients with neoplastic involvement 1.

Overall Complication Rates

The Society of Neurointerventional Surgery guidelines establish clear benchmarks: complication rates should not exceed 2% for osteoporotic fractures and 10% for neoplastic fractures 1. Any practice exceeding these thresholds warrants immediate review of technique and patient selection.

Specific Risks by Category

Cement Leakage (Most Common)

  • Occurs in 27-72% of cases on CT imaging, but the vast majority remain asymptomatic 1
  • Most leaks are discal or into segmental veins
  • Pulmonary cement emboli detected on CT in 26% of patients, yet all remained asymptomatic with no reactive pulmonary changes 1
  • Spinal canal leakage is rare when proper technique is used

Serious Complications (Rare but Critical)

Mortality risk is 0.5% overall, with deaths attributed to 1:

  • Cement pulmonary embolus (1 case)
  • Chest infections following general anesthesia (2 cases)
  • Sepsis after emergency spinal decompression (2 cases)

Severe complications occur in approximately 2% of patients 1, including:

  • Symptomatic pulmonary emboli (4 cases in 987 patients)
  • Hemothorax (1 case)
  • Emergency decompression for hematoma or neuropathy (13 cases)

Neurological Complications

  • Nerve or spinal cord injury resulting in paralysis
  • Bowel/bladder dysfunction
  • Need for emergent decompression
  • Nerve injury risk is slightly higher in office-based settings 2

Cardiovascular/Pulmonary

  • Pulmonary embolus (from cement, air, or fat emboli)
  • Hypotension or depressed myocardial function (from free methylmethacrylate monomer or fat emboli)
  • Cardiovascular collapse (rare)
  • Pneumothorax (specifically for thoracic levels)

Infectious Complications

  • Osteomyelitis
  • Epidural abscess
  • Infection rates are higher in inpatient and outpatient-ASC settings compared to office-based procedures 2

Bleeding/Vascular

  • Vascular injury
  • Paraspinal or soft tissue hematoma

Structural Complications

  • Fracture of rib, pedicle, or vertebral body
  • Secondary/adjacent level fractures occur in 19.4% of vertebroplasty patients versus 18.8% in conservative management (not statistically significant) 1
  • Refracture risk is 18% overall, with steep increase in first 12-24 months postoperatively 3

Other Complications

  • Worsened pain or failure to treat
  • Anaphylaxis to cement (rare)

Risk Factors for Poor Outcomes

Patient-Related Factors

High-risk patients include those with 4, 5:

  • Dependent functional health status preoperatively (OR 1.78-2.92)
  • Pre-operative sepsis/SIRS (OR 2.52)
  • COPD history (OR 1.62)
  • Disseminated cancer (OR 1.94-7.09)
  • Pre-operative dialysis use (OR 11.74 for mortality)
  • Chronic steroid use (OR 3.59 for mortality)
  • Morbid obesity (BMI >40): increased risk of unfavorable discharge (OR 1.24), VTE (OR 1.57), UTI (OR 1.35), and AKI (OR 1.47) 5
  • Female gender, low BMD, smoking, and type 2 diabetes increase refracture risk 6

Procedure-Related Factors

  • Inpatient admission status (OR 3.22-4.95)
  • Pre-operative wound infection (OR 3.47)
  • Cement leakage significantly increases refracture risk 3

Critical Pitfalls to Avoid

  1. Patient Selection: Do not proceed if there is clear disparity between physical examination and imaging, or if an alternative pain source exists 1

  2. Absolute Contraindications 1:

    • Active systemic/spinal infection
    • Uncorrectable bleeding diathesis
    • Insufficient cardiopulmonary health for sedation/anesthesia
    • Known allergy to polymer

  3. Relative Contraindications 1:

    • Significant spinal canal stenosis or compressive myelopathy from retropulsed fragments
    • Radiculopathy exceeding local vertebral pain

  4. Technical Considerations: Ensure high-quality biplane fluoroscopy is available, particularly during cement delivery, and have rapid access to CT/MRI for clinical deterioration 1

Setting-Specific Risk Profiles

Office-based procedures show lower medical complication rates but slightly higher nerve injury and secondary fracture rates compared to inpatient or outpatient-ASC settings 2. However, inpatient procedures carry the highest odds of acute kidney injury, cardiac arrest, DVT, pneumonia, transfusion needs, UTI, and readmissions 2.

References

6
Research

Risk factors for refracture or new vertebral compression fractures after percutaneous vertebroplasty: a systematic review and meta-analysis.

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.