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Kyphoplasty – Vertebral Fracture Treatment Explained

Kyphoplasty is a minimally invasive procedure used to treat vertebral compression fractures. A balloon is inserted into the fractured vertebra to restore its height before bone cement is injected to stabilize it.

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Things worth knowing about "Kyphoplasty"

Kyphoplasty is a minimally invasive procedure used to treat vertebral compression fractures. A balloon is inserted into the fractured vertebra to restore its height before bone cement is injected to stabilize it.

What is Kyphoplasty?

Kyphoplasty is a minimally invasive surgical procedure used to treat vertebral compression fractures. During the procedure, a special balloon catheter is inserted into the fractured vertebra, carefully inflated to restore height and create a cavity, and then removed. The cavity is subsequently filled with bone cement (polymethylmethacrylate, PMMA) to stabilize the vertebra and correct the deformity.

Causes and Indications

Kyphoplasty is typically recommended for the following conditions:

Osteoporotic vertebral compression fractures: The most common indication, caused by bone loss leading to weakened vertebrae.
Tumor-related vertebral fractures: For example, in patients with bone metastases or multiple myeloma.
Traumatic vertebral fractures: Fractures resulting from external forces, provided there is no neurological involvement.
Kummel disease: Avascular necrosis of a vertebral body following trauma.

Symptoms That May Require Kyphoplasty

Patients who may benefit from kyphoplasty commonly experience:

Severe acute or chronic back pain at the fracture site
Reduced mobility and difficulty with daily activities
Loss of height and a forward-stooped posture (kyphosis, sometimes called a dowager hump)
Reduced lung capacity due to the altered vertebral geometry

Diagnosis and Pre-Procedure Assessment

Before kyphoplasty, several diagnostic steps are performed:

X-rays: For an initial assessment of the fracture.
Magnetic Resonance Imaging (MRI): To precisely characterize the fracture, assess its age, and rule out spinal cord involvement.
Computed Tomography (CT): For detailed analysis of vertebral structure and procedural planning.
Bone Density Scan (DXA): To assess bone mineral density when osteoporosis is suspected.

How the Procedure Is Performed

Kyphoplasty is typically performed under general anesthesia or local anesthesia combined with sedation. The procedure involves the following steps:

The patient lies face down on the operating table.
A hollow needle is inserted through a small skin incision into the fractured vertebra under continuous fluoroscopic (X-ray) or CT guidance.
A balloon catheter is advanced through the needle and carefully inflated to restore the height of the collapsed vertebra and create a cavity.
The balloon is deflated and removed.
The resulting cavity is filled with bone cement, which hardens quickly and stabilizes the vertebra.

The procedure typically takes 30 to 60 minutes per treated vertebral level.

Kyphoplasty vs. Vertebroplasty

Kyphoplasty is closely related to vertebroplasty but differs in one key aspect: in vertebroplasty, bone cement is injected directly without prior balloon inflation. Kyphoplasty offers the additional benefit of restoring vertebral body height and correcting kyphotic deformity before cement placement, which is generally considered an advantage.

Treatment Outcomes and Benefits

Clinical studies demonstrate that kyphoplasty can provide the following benefits:

Rapid pain relief: Many patients report significant pain reduction within 24 to 48 hours after the procedure.
Improved mobility: Stabilization of the vertebra allows patients to return to daily activities more quickly.
Partial height restoration: The fractured vertebra can often be partially or fully restored to its original height.
Enhanced quality of life: Reduced pain and improved function contribute to an overall better quality of life.

Risks and Complications

As with any surgical procedure, kyphoplasty carries potential risks:

Cement leakage: Bone cement may leak outside the vertebra, which in rare cases can damage nerves or the spinal cord.
Adjacent fractures: Neighboring vertebrae may be subjected to increased stress after the procedure.
Infection: Rare but possible.
Allergic reactions to the bone cement or contrast agent used during imaging.
Embolism: In very rare cases, cement particles may enter the bloodstream.

Aftercare and Rehabilitation

Following kyphoplasty, the typical post-procedure care includes:

Short inpatient monitoring (usually 1–2 days)
Physical therapy to strengthen the back muscles and improve posture
Medical treatment of underlying osteoporosis to prevent future fractures
Regular follow-up examinations

References

Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. - Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fractures. The Lancet, 2009; 373(9668): 1016–1024.
Boonen S, Van Meirhaeghe J, Bastian L, et al. - Balloon kyphoplasty for the treatment of acute vertebral compression fractures. Journal of Bone and Mineral Research, 2011; 26(7): 1627–1637.
Buchbinder R, Johnston RV, Rischin KJ, et al. - Percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Cochrane Database of Systematic Reviews, 2018.

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