What is kyphoplasty?

From the Guidelines

Kyphoplasty is a highly recommended treatment for symptomatic vertebral compression fractures, as it provides immediate pain relief, restores vertebral height, and improves functional status, as demonstrated by a significant reduction in Roland-Morris disability questionnaire (RDQ) scores, with a mean change of 8.3 points at 1 month, compared to 0.1 points in the control group, as shown in the Cancer Patient Fracture Evaluation study 1.

Key Points

• Kyphoplasty is a minimally invasive surgical procedure that involves inserting a balloon into the fractured vertebra, inflating it to create a cavity, and then filling that space with bone cement to stabilize the fracture and restore vertebral height.
• The procedure is usually performed under local anesthesia with sedation or general anesthesia and typically takes about an hour per treated vertebra.
• Patients often experience immediate pain relief following the procedure and can usually return home the same day.
• Recovery is relatively quick, with most patients resuming normal activities within days.
• Potential risks include cement leakage, infection, bleeding, and nerve damage, though serious complications are rare.
• Kyphoplasty not only addresses pain but also helps correct spinal deformity and may prevent the pulmonary and digestive complications associated with severe kyphosis (forward curvature of the spine).

Benefits of Kyphoplasty

• Immediate pain relief
• Restoration of vertebral height
• Improvement in functional status
• Reduction in risk of pulmonary and digestive complications associated with severe kyphosis
• Can be performed on an outpatient basis
• Quick recovery time

Recommendations

• Kyphoplasty should be considered for symptomatic vertebral compression fractures, especially in patients with cancer, as it provides significant pain relief and improvement in functional status, as shown in the Cancer Patient Fracture Evaluation study 1.
• The procedure should be performed by an experienced physician, and patients should be carefully selected and evaluated for potential risks and benefits.
• Further investigation is needed to determine the role and timing of kyphoplasty in relation to palliative radiotherapy, as suggested by the Cancer Patient Fracture Evaluation study 1.

From the Research

Kyphoplasty Overview

• Kyphoplasty is a minimally invasive surgical technique used to treat vertebral compression fractures (VCFs) resulting from osteoporosis or vertebral body tumors 2, 3.
• The procedure involves the use of a balloon to restore the height of the fractured vertebra and create a cavity for cement injection, which helps to stabilize the fracture and provide pain relief 3, 4.

Comparison with Vertebroplasty

• Kyphoplasty is often compared with vertebroplasty, another minimally invasive surgical technique used to treat VCFs 2, 4.
• Studies have shown that both kyphoplasty and vertebroplasty provide similar long-term improvement in pain and disability, with similar safety profiles and few device-related complications 4, 5.
• However, kyphoplasty may have an advantage over vertebroplasty in terms of reduced cement extravasation and improved height restoration 3, 4.

Risk Factors for New Vertebral Fractures

• New vertebral fractures after kyphoplasty are more common in patients with low bone mineral density and in women 6.
• The risk of new vertebral fracture increases as the bone mineral density decreases 6.
• New vertebral fractures after kyphoplasty often occur in nonadjacent vertebrae, suggesting that osteoporosis is an underlying mechanism 6.

Evidence Base

• The evidence base for kyphoplasty and vertebroplasty is largely based on observational studies and systematic reviews 2, 5.
• Prospective, randomized controlled studies are necessary to objectively compare the two techniques and provide high-quality evidence for their use in the management of VCFs 3, 5.