Clinical Measurement of Intravertebral Pressure
During Vertebroplasty and Kyphoplasty
Authors: Deng Zhong-Liang 
Published: March 2021

Background: Vertebroplasty (VP) and kyphoplasty (KP) are emerging procedures for almost immediate
pain relief when treating osteoporotic or osteolytic fractures. The main reported complication is
polymethylmethacrylate (PMMA) leakage, which may lead to compression of neural structures or
embolism. Different authors have proposed that intravertebral pressure (IP) is an important factor
determining the risk for leakage, although so far only limited information has been gathered from clinical
and experimental studies. There is also a lack of understanding of the IP during conventional interventions
in VP and KP in the clinic.
Objective: 1) To compare the intravertebral pressures of compressed vertebrae and adjacent normal
vertebrae. 2) To measure the IP of compressed vertebrae during VP and KP.
Setting: An interventional pain management practice, a medical center, major metropolitan city, in the
People’s Republic of China.
Methods: Thirty-five patients (with 40 compressed vertebrae and 35 adjacent normal vertebrae) were
randomly allocated for intravertebral pressure measurements. Cannulas were placed bipedicularly into
the posterior third of each vertebral body. Either PMMA or a balloon was injected into the vertebral
body through the right cannula. A manometer was connected to the cannula in the left pedicle, and
heparin was injected to verify the pressure measurement system.
Results: The range (minimum-maximum), average IP, and the standard deviation of the compressed
vertebrae were 0-39 mm Hg and 24.5 ±11.3 mm Hg; and that of adjacent normal vertebrae were 3-16
mm Hg, 7.3 ± 4.2 mm Hg. Furthermore, the average IP for Phase 1 (before PMMA injection) for VP was 23
±11.9 mm Hg; the maximum IP recorded during injection was 169 ± 46.8 mm Hg and the IP for 10 minutes
after injection was 33 ±9.4 mm Hg. Meanwhile, the highest IP recorded for KP patients was 142 ±39.6 mm
Hg. The average IP for Phase 1 (before balloon inflation) was 24 ±12.7mmHg; Phase 2 (peak IP during the
balloon inflation) was 63 ± 25.8 mm Hg; and Phase 3 (after balloon inflation/before PMMA injection) was ,
and 18 ± 10.8 mm Hg. The IP for 10 minutes after injection in KP patients was 36 ± 8.5 mm Hg.
Limitations: The flow rate was manually controlled, which is in line with clinical routine, and was kept
at approximately 0.1 mL/s. Because the speed of injection was controlled by hand, an exact injection
rate could not be assured, leading to some inaccuracy when comparing the IP of VP and KP patients.
Each patient was injected with a different PMMA volume. Because PMMA injection was performed to a
satisfactory vertebral body filling and limited by any signs of extravasation, it was difficult to maintain a
constant injection volume, unlike in vitro studies. Other factors such as the damage to the vertebral shell
or the degree of osteoporosis might also have affected the intravertebral pressure.
Conclusion: This study showed that the IP of compressed vertebrae was significantly higher than that of
adjacent normal vertebrae. There was a significant increase in IP during the PMMA filling in VP and KP; the
IP of compressed vertebrae was not significantly reduced by the balloon inflation in KP, and no statistically
significant differences in IP were found during all common stages of PMMA filling in VP and KP.
Key words: Vertebroplasty, kyphoplasty, intravertebral pressure, PMMA leakage.