Thank you for raising this important and clinically relevant question.

Indeed, vertebroplasty is most commonly indicated for painful vertebral compression fractures—whether due to osteoporosis, trauma, or metastatic disease. However, the use of vertebroplasty for vertebral metastases without overt fracture remains controversial, although some literature supports its role in selected cases.

Several studies suggest that vertebroplasty may offer pain relief even in the absence of radiologically visible fractures, likely due to tumor-induced micro-instability, vertebral body infiltration, and periosteal stretching.

For instance:

• Deramond et al. reported in Radiology (2000) that vertebroplasty can alleviate pain from osteolytic metastases even when fractures are not visible, especially when the lesion causes localized instability or cortical destruction. 📄 Deramond, H. et al. "Percutaneous Vertebroplasty with Polymethylmethacrylate: Technique, Indications, and Results." Radiology, 2000. Link
• The European Society of Medical Oncology (ESMO) and other guidelines acknowledge vertebroplasty as a palliative pain management technique for painful spinal metastases, but emphasize careful patient selection, especially when no fracture is evident.

That said, MRI evidence of marrow infiltration and focal pain corresponding to the lesion might justify vertebroplasty in selected cases. A multidisciplinary evaluation involving spine surgeons, interventional radiologists, and oncologists is essential.

In summary, while vertebroplasty without fracture is not standard, it may be considered in specific patients with intractable pain, vertebral metastasis, and evidence of local instability or tumor burden, even without overt collapse.

Best regards, Dr. Zein Al-Abideen Douba MSc Laboratory Diagnostics | Researcher in Cancer Biomarkers Tishreen University, Syria