From the Guidelines
Kyphoplasty is primarily indicated for the treatment of painful vertebral compression fractures that have not responded to conservative management, particularly in patients with acute or subacute fractures due to osteoporosis, cancer-related vertebral metastases, or multiple myeloma. The procedure is most appropriate for patients who experience significant pain that limits daily activities, with pain that correlates with the fracture location, is less than 6-8 weeks old, and shows evidence of bone edema on MRI 1. Kyphoplasty may also be considered for older fractures if there is persistent pain and evidence of non-healing. The procedure involves inserting a balloon into the fractured vertebra, inflating it to create a cavity, then injecting bone cement to stabilize the fracture and potentially restore vertebral height, providing rapid pain relief by preventing painful micromotion at the fracture site and stabilizing the spine 1.
Key Considerations
- Ideal candidates for kyphoplasty have pain that correlates with the fracture location and shows evidence of bone edema on MRI 1.
- Kyphoplasty is contraindicated in patients with active infections, coagulopathy, vertebral fractures with spinal cord compression, or fractures that are completely healed or asymptomatic 1.
- The procedure is generally performed under conscious sedation or general anesthesia and typically requires only a short hospital stay, with many patients experiencing significant pain relief within 48 hours 1.
Benefits and Outcomes
- Kyphoplasty has been shown to provide immediate and considerable improvement in pain and patient mobility, with over 90% of patients experiencing short-term pain improvement and over 60% experiencing functional improvements 1.
- The procedure can also reduce local cancer recurrence and improve pulmonary function in patients with vertebral compression fractures 1.
From the Research
Indications for Kyphoplasty
The indications for kyphoplasty, a minimally invasive technique for fracture reduction and stabilization, include:
- Osteoporotic vertebral compression fractures (VCFs) 2, 3, 4
- Fresh vertebral compression fractures associated with osteoporosis, trauma, malignant conditions, hemangiomas, and osteonecrosis 3
- VCFs with neurological deficits and anterior vertebral wall destruction, such as in cancer patients with spinal metastasis 5
- Painful osteoporotic VCFs, with the goal of reducing pain and improving functional outcome 6
Patient Selection
Kyphoplasty can be performed in patients with:
- Acute or chronic VCFs, with better outcomes achieved in acute fractures 2
- Severe osteoporosis or osteolysis due to tumor metastasis 5
- Large bony defects in the vertebra, using a slow injection of highly viscous bone cement 5
- Patients who have failed conservative treatment or have significant pain and disability due to VCFs 4
Clinical Outcomes
Kyphoplasty has been shown to:
- Reduce pain and improve functional outcome in patients with VCFs 2, 3, 6
- Restore vertebral body height and correct local kyphosis 2, 6
- Improve patient-reported indexes, such as pain assessment and Oswestry Disability Index for Back Pain 2
- Have a low complication rate, with asymptomatic cement leakage occurring in a small percentage of cases 3, 6