Kyphoplasty

Kyphoplasty is one option for a painful vertebral compression fracture, most often related to osteoporosis but sometimes associated with trauma or disease that weakens bone. A compression fracture causes part of a vertebral body to collapse. Some fractures improve with time and nonoperative care; others continue to cause focal pain that limits standing, walking, sleep, or basic activity.

The presence of a compressed vertebra on an X-ray does not by itself mean kyphoplasty is appropriate. Many people have older compression deformities that are no longer painful. The central question is whether a specific, active fracture is the source of the current symptoms and whether stabilizing it is likely to offer more benefit than continued conservative treatment.

What kyphoplasty is designed to do

The procedure is intended to stabilize movement within a fractured vertebral body. Through a small skin opening, the surgeon guides a narrow instrument into the vertebra using real-time imaging. A small balloon is expanded to create a controlled space within the fractured bone. The balloon is then removed, and bone cement is placed into that cavity. The cement hardens and supports the treated vertebra.

Kyphoplasty may restore some lost height in certain fracture patterns, but height correction is not assured and is not the only goal. The more practical goal is to reduce pain associated with an unstable or unhealed fracture so that the patient can move more comfortably and avoid the complications of prolonged inactivity.

Kyphoplasty does not reverse osteoporosis, treat generalized back pain, decompress a pinched nerve, or correct a large spinal deformity. If symptoms arise from another condition, a different treatment plan may be needed.

How candidacy is evaluated

A thoughtful evaluation looks for agreement among the history, examination, and imaging. Important questions include:

• Did the pain begin suddenly after a fall, lift, cough, or without a clear event in a person with weak bone?
• Is the pain focal and mechanical, often worse with standing, walking, transfers, or position changes?
• Does examination identify tenderness near the same spinal level seen on imaging?
• Does MRI show an active or incompletely healed fracture rather than only an old deformity?
• Have pain control, activity modification, bracing, or other appropriate measures provided enough relief?
• Are there medical, bleeding, infection, anesthesia, or bone-health issues that change the risk of a procedure?

MRI is often useful because marrow changes can help estimate whether a fracture is recent or still active. CT may clarify fracture anatomy or the integrity of the vertebral walls. Plain radiographs show alignment and collapse over time. Imaging is interpreted in the context of symptoms; no single scan decides candidacy on its own.

When another approach may be safer

Kyphoplasty may not be appropriate when the fracture is old and healed, pain comes from a different structure, there is active infection, or bleeding risk cannot be safely managed. Fractures that significantly narrow the spinal canal, cause neurologic compression, or reflect substantial instability may require a different operation. Suspected cancer-related fractures require coordinated evaluation of the underlying disease and may involve oncology or radiation treatment in addition to, or instead of, cement augmentation.

Nonoperative and procedural alternatives

Many stable compression fractures are initially managed without a procedure. The plan may include medication selected for the patient’s health profile, temporary bracing, gradual walking, modification of painful activities, and physical therapy when the acute pain allows. Prolonged bed rest is generally avoided because immobility can worsen weakness, balance, and medical risk.

Bone health is a separate but essential part of treatment. Evaluation may include bone-density testing, laboratory assessment, nutrition review, and osteoporosis medication through the appropriate clinician. Fall prevention and safe strengthening help reduce future risk.

Vertebroplasty is another cement-augmentation technique that does not use a balloon. Continued observation may remain reasonable when symptoms are improving. Open stabilization is uncommon for a routine osteoporotic compression fracture but may be considered for severe instability, deformity, or neurologic compromise. The best choice depends on the fracture pattern and the patient’s overall goals and risk.

What happens during the procedure

Kyphoplasty is performed with anesthesia and continuous imaging guidance. The patient is positioned to allow safe access to the involved level. After the fractured vertebra is confirmed, one or two narrow access channels are placed through the bony pedicles or another planned route. The balloon creates the cavity, then cement is delivered slowly while its position is watched on imaging.

The number of levels treated, anesthesia plan, and whether discharge occurs the same day depend on the individual case. The surgical team checks strength, sensation, pain control, walking safety, and the access sites before discharge.

Benefits, limits, and risks

For a well-selected active fracture, stabilization may lessen fracture-related pain and make mobility easier. The degree and timing of improvement vary. Persistent pain can occur when the fracture is not the only pain generator or when the vertebra does not respond as expected.

Risks include bleeding, infection, anesthesia complications, injury to a nerve or nearby structure, cement leakage, blood-vessel or lung complications from cement, allergic reaction, and need for additional treatment. Small cement leaks may cause no symptoms, but leakage into the spinal canal or circulation can be serious. A treated patient can also experience future fractures at other levels because the underlying bone disease remains.

Recovery and long-term fracture prevention

Walking often begins soon after the procedure, but the first days should follow the written discharge plan. Incision care, medication use, lifting limits, driving, return to work, and physical therapy are tailored to fracture burden, balance, medical conditions, and the demands of daily life. Follow-up assesses whether pain and function are improving and whether additional imaging is needed.

Recovery is not complete when the cement hardens. A durable plan also addresses osteoporosis, vitamin and nutrition needs, fall risk, muscle conditioning, vision or balance problems, and medications that may affect bone. These steps cannot eliminate the possibility of another fracture, but they address the disease process that kyphoplasty itself does not treat.

When symptoms need urgent evaluation

New leg weakness, loss of sensation around the groin, new loss of bladder or bowel control, fever with worsening back pain, chest pain, shortness of breath, or severe rapidly increasing pain requires prompt medical evaluation. After a procedure, drainage, spreading redness, escalating swelling, or a new neurologic change should be reported immediately. Severe or rapidly progressing symptoms should be evaluated in the nearest emergency department.