Kyphoplasty: Minimally Invasive Procedure for a Spinal Compression Fracture

What is kyphoplasty?

Kyphoplasty is a minimally invasive procedure where bone cement is injected to stabilize vertebral compression fractures for immediate pain relief. Expandable balloons or implants are then inserted to restore the natural height of one or more damaged vertebrae and cement is injected for fixation.

What conditions does kyphoplasty treat?

Kyphoplasty treats painful vertebral compression fractures, in which spinal vertebrae fracture and collapse. These fractures can pinch nerves and/or disrupt soft tissue around the spine, causing pain and instability. A kyphoplasty reinstates the structural integrity of the vertebra.

Patients whose painful compression fractures are treated without surgery or other interventions have a higher risk of death – up to 55% more – compared to those who have a kyphoplasty. This is because the pain can lead patients to be bedridden and taking pain medications such as opioids. This combination can lead to blood clots and pneumonia.

Who is a candidate for kyphoplasty?

Any patient with a painful vertebral compression fracture is a candidate for kyphoplasty.

Is kyphoplasty an inpatient or outpatient procedure?

Kyphoplasty is typically a same-day outpatient procedure done under moderate sedation rather than general anesthesia.

What is the difference between a kyphoplasty and vertebroplasty?

In a kyphoplasty, balloons or implants are used to restore the vertebra’s height loss caused by the compression fracture before the cement is injected. A vertebroplasty the injection of the fixating cement alone. Currently, due to its benefits of height restoration and cavity creation with better cement injection control, kyphoplasty is most commonly performed. Vertebroplasty will be done in some cases of chronic spinal compression fractures that may not allow for kyphoplasty balloons to deploy.

What happens during kyphoplasty?

Using fluoroscopy (a low-powered X-ray machine) for guidance, a needle is inserted into the fractured vertebral body percutaneously. Needle access into the vertebral body may be unipedicular (a needle going through one pedicle of the vertebra) or bipedicular (in which needles are deployed through two pedicles).

Newer curved needles which can direct the cement toward the other side of the vertebral body allow clinicians to use a unipedicular approach. However, no significant clinical outcome difference has been shown regardless of the unipedicular or bipedicular access technique.

After insertion of a balloon or a titanium implant to restore the height, bone cement is injected into the vertebral body to fixate the fracture. A titanium implant is used in cases where it is necessary to the maximize vertebral height restoration. But multiple factors come into play when determining whether to use the balloon or the titanium implant, including: the extent of the height loss, the chronicity of the fracture, and whether titanium implants will fit in the damaged vertebrae.

How long does kyphoplasty take?

It depends on the number of levels but the procedure itself usually takes 30 minutes.

How long is the recovery after kyphoplasty?

The pain from the fracture usually subsides immediately following the procedure but the patients may have mild soreness at the needle entry sites which wears off in a day or two.

What is the success rate of kyphoplasty?

Kyphoplasty is an extremely successful procedure where on average pain level can decrease from 9-out-of-10 level pain to a 3-out-of-10 pain level.

Is kyphoplasty painful?

Kyphoplasty is done with local anesthesia and sedation administered by an anesthesiologist, so patients do not feel any pain during the procedure.

What are the potential complications of kyphoplasty?

Anytime a procedure is performed in the spine, there is a risk of injury to the neural elements. The bone cement can also leak into surrounding structures. However, that is why the fluoroscopic guidance is used during the procedure – to minimize these risks. Kyphoplasty is proven to be an extremely safe procedure with minimal complication rates.

Will I have a follow-up visit with my doctor?

The follow-up is usually done within 2 to 4 weeks following the procedure and follow up imaging is usually not performed unless the patient complains of new pain.

Is kyphoplasty safe for elderly patients?

Kyphoplasty is an extremely safe procedure, and it is routinely performed on elderly patients given that most compression fractures occur in older patients who have osteoporosis. Osteoporosis of the spine is one of the chief risk factors for developing a compression fracture.

Is kyphoplasty permanent?

Kyphoplasty fixates the compression fracture and is usually permanent.

What kind of doctor performs kyphoplasty?

The procedure is usually performed by interventional radiologists and other physicians who perform procedures of the spine.

Posted: 5/3/2024

Authors

References

• Beall DP, Chambers MR, Thomas S, Amburgy J, Webb JR Jr, Goodman BS, Datta DK, Easton RW, Linville D 2nd, Talati S, Tillman JB. Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial. Neurosurgery. 2019 Jan 1;84(1):169-178. doi: 10.1093/neuros/nyy017. PMID: 29547939; PMCID: PMC6354561.
• Williams TD, Adler T, Smokoff L, Kaur A, Rodriguez B, Prakash KJ, Redzematovic E, Baker TS, Rapoport BI, Yoon ES, Beall DP, Dordick JS, De Leacy RA. Bone Cements Used in Vertebral Augmentation: A State-of-the-art Narrative Review. J Pain Res. 2024 Mar 13;17:1029-1040. doi: 10.2147/JPR.S437827. PMID: 38505504; PMCID: PMC10949389.

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