From the Guidelines
Kyphoplasty is indicated for patients with painful vertebral compression fractures, particularly those with cancer, as it provides immediate pain relief and improves functional status. The procedure is most beneficial for patients with symptomatic vertebral compression fractures who have not responded to conservative management, as evidenced by the Cancer Patient Fracture Evaluation study, which showed a significant improvement in back-specific functional status measured by the Roland-Morris disability questionnaire (RDQ) score at 1 month in patients who underwent kyphoplasty compared to those who received nonsurgical management 1.
Key Indications for Kyphoplasty
- Painful vertebral compression fractures in patients with cancer
- Symptomatic vertebral compression fractures that have not responded to conservative management
- Patients with moderate to severe pain that limits daily activities
- Acute fractures (less than 8-12 weeks old) with at least 15% loss of vertebral height
Benefits of Kyphoplasty
- Immediate pain relief
- Improvement in functional status
- Avoiding delays in chemoradiation
- Outpatient care in the majority of cases
- Biopsy of tissue
- Vertebral height restoration
- Potential antitumor effect of bone cement
Patient Selection
Patients should have pain that correlates with the fracture level on imaging and have failed conservative measures, including analgesics, bracing, and physical therapy. Kyphoplasty is particularly beneficial for elderly patients who cannot tolerate prolonged bed rest or strong pain medications. Contraindications include asymptomatic fractures, fractures older than 1 year, spinal cord compression, active infection, coagulopathy, and vertebra plana (complete collapse) 1.
From the Research
Indications for Kyphoplasty in Compression Fracture
- Osteoporotic vertebral compression fractures (VCFs) are a common indication for kyphoplasty, as this procedure can reduce pain and restore vertebral body height in patients with VCFs 2, 3, 4.
- Both acute and chronic VCFs can be treated with kyphoplasty, although the clinical and radiological outcomes may be better in acute fractures than in chronic fractures 2, 5.
- Kyphoplasty can be used to treat painful thoracic and lumbar compression fractures, and it has been shown to have improved pain reduction and lower complication rates compared to standard vertebroplasty 3, 6.
- The procedure can be performed with a transpedicular or extrapedicular access, and polymethyl methacrylate (PMMA)-cement is commonly used due to its favorable biomechanical properties and effect on pain reduction 3.
Key Considerations
- The timing of kyphoplasty may matter, as the clinical and radiological outcomes were mostly better in acute fractures than in chronic fractures 5.
- Kyphoplasty can achieve the same degree of pain relief as vertebroplasty, but may offer additional benefits of fewer complications, more indications, better biopsy specimens, and potential for height restoration of compression fractures of the spine 6.
- Common complications of kyphoplasty include cement leakage and adjacent segment fractures, while rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection 3.