Kyphoplasty for Vertebral Compression Fractures with Less Than 50% Height Loss
Kyphoplasty is medically indicated for patients with persistent, localized vertebral pain secondary to compression fractures, even when vertebral height loss is less than 50%, provided the affected vertebra maintains at least 1/3 of its original height and has an intact posterior cortex 1.
Patient Selection Criteria
Kyphoplasty can be considered for patients with:
- Confirmed thoracic/lumbar vertebral fracture
- Failure of conservative management (typically 3 weeks of trial)
- Pain causing loss of mobility and inability to perform baseline activities
- No osteomyelitis at surgical site
Risk Factors for Failed Conservative Treatment
Patients with the following characteristics may benefit from earlier kyphoplasty intervention, as they have higher risk of failing conservative treatment 2:
- Age older than 78.5 years
- Severe osteoporosis (T-score less than -2.95)
- BMI more than 25.5
- Collapse rates more than 28.5%
Efficacy Based on Vertebral Height Loss
- Kyphoplasty has demonstrated effectiveness across various degrees of vertebral height loss, including cases with less than 50% height loss 3
- In patients with severe collapse (>70% height loss), kyphoplasty can still significantly improve pain and restore vertebral height, though technical challenges increase 3
- Restoration of vertebral height is possible in both acute and chronic fractures, though better results are achieved in acute fractures (within 10 weeks of injury) 4
Clinical Outcomes
- 84% of patients with metastatic disease experience marked or complete pain relief following kyphoplasty 1
- Significant improvement in functional status compared to nonsurgical management 1
- Immediate pain relief in approximately 89% of patients 5
- Reduction in narcotic usage and improved Oswestry Disability Index scores 4
Vertebral Height Restoration
- Greater than or equal to 20% restoration of lost vertebral height (anterior) observed in 63% of fractures with an overall mean restoration of 30% 5
- Greater than or equal to 20% restoration of lost vertebral height (midline) detected in 69% of fractures with an overall mean restoration of 50% 5
- Mean restoration of 45% of lost vertebral height has been reported 6
Timing Considerations
- Acute fractures (<10 weeks old) show better height restoration compared to chronic fractures (>4 months old) 4
- 60% of acute fractures achieve restoration to ≥89% of normal vertebral height, compared to 26% of chronic fractures 4
- Early intervention may provide better outcomes, but even chronic fractures can benefit from kyphoplasty 4
Potential Complications
- Cement leakage (rare but possible)
- Adjacent/remote level vertebral compression fractures (reported in approximately 12% of patients) 5
- Device-related complications (uncommon)
Procedural Approach
- A unilateral transpedicular approach may be sufficient in many cases
- Proper positioning of the bone expander in the midline of the vertebral body is key
- Can be performed under local anesthesia with the patient in prone position
- Careful cement injection technique can prevent leakage, even with vertebral wall defects
Kyphoplasty represents a valuable intervention for patients with vertebral compression fractures regardless of the degree of height loss, provided appropriate patient selection criteria are met and the procedure is performed by experienced practitioners.