The spine is composed of multiple bony segments called vertebrae.  The weight bearing areas of the spine are located in the lower thoracic and upper lumbar spine which make them more susceptible to compression fractures.  The bony vertebra is mostly solid on the outside but inside the vertebral body, it has holes in it.  Patients with osteoporosis have larger holes like "Swiss cheese", which make them easier to fracture even following minor trauma caused by coughing or straining.  Most of the compression fractures are located close to the vertebral endplates and the resultant fracture causes loss of height of the vertebral body.

The aim of percutaneous vertebroplasty is to fill in the holes with cement during the procedure.  The cement works as an "internal cast" that stabilizes the fracture with resultant pain relief and prevention of further compression of the vertebra.  The cement is an acrylic bond, polymethylmethacrylate (PMMA), made of two components, a powder and a catalyst.  Included in the mixture are antibiotics that lessen the risk of infection, and sterilized barium, a contrast medium that allows x-ray fluoroscopic visualization of the cement during the procedure.

The procedure is performed in the angiography suite with live imaging in two orthogonal planes for optimum monitoring of needle placement and cement injection.  Conscious sedation with intravenous drugs are administered during the procedure under continuous monitoring by dedicated nursing personnel.  The patient for vertebroplasty must lie on his or her belly (prone position) while the interventional neuroradiologist and his team precisely locate the affected area under live x-ray fluoroscopy.  The procedure of vertebroplasty basically consists of performing a small skin incision about 1 cm in the patient's back, a needle inserted through the skin incision to the fractured vertebra and injection of a bone cement solution at the site of the fracture.  Usually treatment of one vertebral body will require placement of two separate needles in the right and left side of the vertebral body.  Each procedure of needle insertion and cement injection usually lasts about 10 minutes.  In patients with multiple vertebral body fractures, multiple fracture sites can be treated and the number of sites treated will depend upon patient tolerance.