Kyphoplasty

The spine is a stack of bones called vertebrae. When one of these bones is weak, it can crack and collapse, like a sugar cube pressed flat. This is a vertebral compression fracture. It often happens with little or no injury, such as bending to lift a bag, coughing or getting out of a chair.

The typical symptom is sudden, sharp back pain at the level of the fracture, worse when you stand, walk or turn in bed, and better lying still. Several fractures can cause a loss of height and a rounded, hunched upper back (kyphosis), which can make breathing and eating harder.

On MRI, a new fracture looks bright on a special water-sensitive image because the broken bone is swollen. An old, healed fracture does not. This is the key test for deciding whether kyphoplasty is likely to help.

Kyphoplasty and vertebroplasty are closely related procedures that stabilize a fractured vertebra with medical-grade bone cement. Using live X-ray, the doctor guides a needle through the back into the broken bone. In kyphoplasty, a small balloon is first inflated inside the bone to create a space and sometimes restore a little height, then the cement fills that space. In vertebroplasty, cement is injected without a balloon.

The cement hardens in about 10 to 20 minutes and acts like an internal cast. It stops the broken pieces from moving against each other, which is the main source of pain.

Most compression fractures heal on their own in about 6 to 12 weeks with pain medicines, a back brace, gentle activity and time. Kyphoplasty is considered when pain is severe, keeps you in bed, or does not improve with those measures, or when pain medicines cause problems such as confusion, constipation or falls.

Research on these procedures has had mixed results. Some studies comparing vertebroplasty with a sham (fake) procedure found little difference, while others, especially those treating very recent and very painful fractures, found faster and greater pain relief with cement. Kyphoplasty studies have shown better pain relief and function than non-surgical care in the first months. Medical societies, including radiology and spine groups, support these procedures for carefully chosen patients.

On the day, a nurse will place an IV, check your vital signs and may give antibiotics and anti-nausea medicine. More general advice is on before your procedure and sedation.

1. 1
   Positioning

   You lie on your stomach on padded supports. You receive moderate sedation through your IV, or sometimes general anesthesia, and the skin of your back is cleaned and numbed.

2. 2
   Placing the needles

   Using live X-ray from two directions, the doctor guides one or two hollow needles through the back of the vertebra into the fractured bone. If cancer is suspected, a small bone sample (biopsy) can be taken now.

3. 3
   Balloon and cement

   A small balloon is inflated inside the bone to make a cavity, then removed. Thick bone cement is slowly injected under continuous X-ray to fill the space.

4. 4
   Finishing

   The needles are removed and the tiny punctures are sealed with skin glue. The procedure takes about 1 hour for one level, a little longer for more.

Afterward, you lie flat for about 1 to 2 hours while the cement fully sets and nurses check you. Most people walk before going home the same day. Some, especially those already in the hospital, stay overnight.

1. First 24 hours
   Rest at home. No driving, alcohol or important decisions after sedation. Soreness at the needle sites is normal. Ice packs and acetaminophen (Tylenol) help.
2. Days 1 to 3
   Many people notice their fracture pain is clearly better. Walk short distances several times a day. You can shower after 24 hours, but do not soak in a bath or pool for 1 week.
3. Weeks 1 to 6
   Slowly increase activity. Avoid lifting more than about 10 pounds and heavy bending or twisting. Your doctor may taper your pain medicines.
4. After 6 weeks
   Most people are back to their usual activities. Treating the underlying bone weakness becomes the priority.

Most people with a recent painful fracture get significant pain relief, often within a day or two, and can move more easily and use fewer pain medicines. Studies often report good relief in about 3 in 4 people or more.

Kyphoplasty treats the fracture, not the osteoporosis. Having one fracture raises the chance of another. Ask your primary care doctor or an endocrinologist about a bone density test (DEXA), calcium, vitamin D, exercise, fall prevention and medicines that strengthen bone.

Before I recommend kyphoplasty, I compare where you hurt with what the MRI shows. When the tender spot on your back lines up with a fresh, swollen fracture, the chance of good relief is high. I also remind patients that the fracture is a warning sign about bone strength, so we make sure someone is looking after their osteoporosis or their cancer treatment as well.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Kyphoplasty is generally safe, and serious problems are uncommon.