Kyphoplasty inflates a balloon inside the collapsed vertebra before cement goes in; vertebroplasty injects cement directly into the bone as it sits. That balloon step is the entire difference, and it is why only kyphoplasty is described as restoring height. What the comparison studies actually show is that the height gained is measured in millimeters, that much of it is lost again under normal loading, and that it has never been shown to be the reason patients feel better.
This page compares the two procedures on height specifically. If you are earlier in the process and want to understand the fracture itself — how the bone fails, what the placebo-controlled trials found, and whether cement is warranted at all — start with vertebral compression fracture and sudden back pain.
The mechanical difference
Bone is not a hollow container. A vertebral body is a trabecular lattice, and a compression fracture is that lattice buckling under load.
Kyphoplasty passes a balloon tamp into the fractured body, inflates it to create a cavity, removes it, and fills the void with polymethyl methacrylate cement. Vertebroplasty skips the balloon and injects cement under pressure directly into the existing lattice.
Both end with cement in bone. Only one attempts to change the shape of the vertebra before that happens. Neither rebuilds bone — cement splints, it does not mineralize.
What the height numbers actually show
A comparative review in Current Reviews in Musculoskeletal Medicine put the difference in millimeters rather than percentages. Immediately after the procedure, the kyphoplasty group averaged 2.7 mm of height restoration against 0.7 mm for vertebroplasty.1
That is a real difference, and it is smaller than most patients picture when they hear “height restoration.”
The same review reports the more important caveat: those initial gains did not hold under repetitive loading. The kyphoplasty specimens lost an average of 4.2 mm, the vertebroplasty specimens 1.1 mm.1 The procedure that gains more height also gives more of it back once the spine goes back to work.
A separate figure from the same review — 97% restoration of original height with kyphoplasty against 30% with vertebroplasty — is often quoted without that loading context.1 Read on its own it suggests a near-complete anatomical correction. Read alongside the loading data, it describes a measurement taken at the best possible moment.
Height is not the outcome you came for
Height is easy to photograph. Pain is the reason anyone is in the room.
No trial has established that the millimeters gained are what produces symptom relief. Both procedures aim to stabilize micromotion across the fracture line, and stabilization is the mechanism most consistent with what patients report. Whether cement also affects nerve endings within the bone remains hypothesis rather than established mechanism.
This matters when a procedure is offered on the strength of the height argument alone. If height restoration is presented as the reason to choose kyphoplasty, ask what outcome that height is expected to change.
What happens after the cement
A vertebral compression fracture is a marker of bone that is failing generally, not locally. Compression fractures carry roughly a five-fold increased risk of further fractures, whether adjacent or distant.2
Neither procedure changes that trajectory. A propensity-matched analysis in Cureus found that within one year, 55.7% of kyphoplasty patients and 51.9% of vertebroplasty patients sustained a subsequent thoracic or lumbar fracture.3 Both numbers are high, and they are close to each other.
That is the most useful comparison on this page. The choice between balloon and no balloon moves height by millimeters. It does not meaningfully move what happens to the rest of the spine over the following year. What changes that is treating the bone disease — and cement is not a treatment for osteoporosis.
Patient selection decides more than technique
An acute fracture with marrow edema on MRI behaves differently from a chronic, healed deformity. The height-restoration question only has meaning while the fracture is still biologically active; a vertebra that consolidated months ago will not re-expand.
We also look at why the bone failed. Osteoporosis, poorly controlled diabetes, vitamin D status and nutritional deficits are not background details on a fracture work-up — they are the reason the fracture happened and the reason the next one will.
The most common defensible answer to “which of these two should I have” is that the fracture does not yet warrant either. Many settle on their own over 6 to 12 weeks.
Where this fits in the rest of your care
At Padda Institute Center for Interventional Pain Management, a fracture is evaluated as part of a system rather than as an isolated lesion. Pain that persists after a vertebra is stabilized frequently belongs to a different generator — the facet joints, an irritated nerve root, or a sensitized central nervous system that no longer needs peripheral input to keep firing.
That is why the work-up may lead to a facet joint injection or a diagnostic nerve block rather than to more cement, and why imaging alone does not settle the question. Dr. Padda covers that reasoning in what imaging can and cannot show about pain.
The full range of options is listed under pain treatments, and the clinical team is introduced on the pain management doctors in St. Louis page.
Dr. Padda discusses vertebral compression fractures and what cement actually does in this video on the practice’s channel: Vertebral Compression Fracture: Why a Cough Can Break a Spine.
Frequently asked questions
Does kyphoplasty restore more height than vertebroplasty?
Yes, but by millimeters rather than by transformation — about 2.7 mm against 0.7 mm immediately after the procedure, with much of that gain lost again under repetitive loading. The procedures and their indications are described on the kyphoplasty page.
Does vertebroplasty restore any height at all?
It is not designed to. Vertebroplasty stabilizes the vertebra in its current shape, and the small measured gains are incidental to cement filling the lattice. See the vertebroplasty page for when it is appropriate.
Does restoring height reduce pain?
That has not been established. Both procedures are understood to work, when they work, by reducing micromotion across the fracture. The evidence on symptom relief is covered in detail in vertebral compression fracture and sudden back pain.
Will either procedure stop me from fracturing again?
No. Roughly half of patients in a matched one-year analysis sustained another thoracic or lumbar fracture regardless of which procedure they had. Lowering that risk means treating the underlying bone disease, not the individual vertebra.
What if my back still hurts after the cement?
Persistent pain usually points to a different pain generator, such as the facet joints or an irritated nerve root. Those are tested directly with a facet joint injection or a nerve block rather than assumed from imaging.
How do I get evaluated in St. Louis?
Padda Institute Center for Interventional Pain Management is at 4477 Woodson Road, Suite 100, St. Louis, MO 63134, next to St. Louis Lambert International Airport, with a second location at 12174 Natural Bridge Road, Bridgeton, MO 63044. Call (314) 481-5000 or text (314) 886-5902, Monday through Friday, 8:00 AM to 5:00 PM. Bring your imaging, or request an appointment.
Sources
- McCall T, Cole C, Dailey A. Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events. Current Reviews in Musculoskeletal Medicine. 2008. PMC2684146
- Munakomi S, Stretanski MF, Das JM. Vertebral Augmentation. StatPearls. NBK547726
- Belt NG, Lee A, Sanghvi P, Mistovich RJ, Belding J. Comparative Long-Term Outcomes of Vertebroplasty Versus Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Propensity-Matched Analysis. Cureus. 2025. PMC12688411
Dr. Gurpreet Singh Padda, MD, MBA, MHP
