What condition does kyphoplasty treat?

What Condition Does Kyphoplasty Treat?

Kyphoplasty treats painful vertebral compression fractures (VCFs), primarily those caused by osteoporosis and cancer-related metastatic disease. 1

Primary Indications

Osteoporotic Vertebral Compression Fractures

• Kyphoplasty is indicated for patients with painful osteoporotic VCFs who have failed conservative medical therapy (analgesics, bed rest, back braces, physical therapy). 1, 2
• The procedure provides substantial pain relief and improved mobility in the majority of patients with osteoporotic fractures. 1
• Both acute fractures (less than 10 weeks old) and chronic fractures (more than 4 months old) can be treated, though acute fractures achieve better height restoration (60% vs 26% achieving ≥89% of normal vertebral height). 3

Cancer-Related Vertebral Compression Fractures

• Kyphoplasty has stronger evidence supporting its use in cancer-related fractures than in osteoporotic fractures. 2
• The American College of Chest Physicians provides a Grade 1A recommendation (highest level of evidence) for vertebral augmentation procedures in lung cancer patients with painful VCFs. 4
• The National Comprehensive Cancer Network specifically recommends kyphoplasty for patients with secondary osteolytic metastasis in the thoracic and lumbar vertebrae. 4
• Cancer patients experience worse natural history than osteoporotic patients due to continued bone loss from tumor invasion, poor nutritional status, immobilization, and effects of cancer treatments. 4

Additional Indications

Other Treatable Conditions

• Painful vertebral hemangiomas can be treated with kyphoplasty. 5
• Traumatic VCFs may be amenable to treatment, though evidence is less robust. 5
• Pathologic spinal fractures with spinal deformity or pulmonary dysfunction are appropriate for vertebral augmentation according to ACR Appropriateness Criteria. 4

Clinical Benefits Beyond Pain Relief

Functional Improvements

• Kyphoplasty provides significant pain reduction, with earlier achievement of significant pain relief compared to conservative treatment (30 days vs 116 days). 2
• In cancer patients, 75% achieved a Karnofsky Performance Status score of at least 70 (threshold for self-care) compared to 39% with conservative treatment. 2, 4
• The procedure improves quality of life scores across multiple validated instruments. 1, 2

Anatomic Correction

• Kyphoplasty addresses both pain and kyphotic deformity by creating a cavity before cement deposition, potentially improving spinal alignment. 6
• Mean vertebral body height significantly improves after kyphoplasty (acute fractures: 58% to 86% of estimated normal height; chronic fractures: 56% to 79%). 3
• Local kyphosis significantly improves (acute fractures: 15° to 8°; chronic fractures: 15° to 10°). 3

Important Clinical Caveats

Patient Selection Criteria

• Pain must be localized to the level of pathology being treated, with other causes ruled out by MRI and CT imaging. 4
• Patients should have failed conservative management and be experiencing significant pain (typically >6/10 on visual analogue scale). 4, 7
• Recent fracture must be evident on cross-sectional imaging (CT or MRI STIR T2) to supplement spine X-rays. 7

Comparison to Vertebroplasty

• Kyphoplasty and vertebroplasty show similar clinical outcomes in pain relief and mobility at similar complication rates. 1
• Kyphoplasty costs approximately 2.5 times more than vertebroplasty due to additional equipment, anesthesia, and hospital costs. 1, 2
• No head-to-head studies have definitively compared the two procedures. 2
• Kyphoplasty reduces the risk of extravertebral cement leakage by creating an intravertebral cavity. 6