Kyphoplasty

In balloon kyphoplasty, a needle is placed into the fractured vertebral body under X-ray guidance, and a balloon (or tamp) is inflated to compact the broken bone and create a space. The balloon can help lift the collapsed vertebra towards its original height and reduce the angular deformity of the fracture. It is then deflated and removed, and bone cement is injected into the cavity it has created. Because the cavity is formed first, the cement can often be delivered at lower pressure and in a more contained way than in vertebroplasty.

Kyphoplasty is used mainly for painful osteoporotic compression fractures that are not settling with time and non-surgical care, and it is a well-established option for painful fractures caused by cancer in the spine. It may be particularly considered where there is significant height loss or kyphotic deformity that could benefit from some correction. As with vertebroplasty, it is not a treatment for back pain in general, and careful patient selection based on the fracture and the symptoms is central to a good result.

The evidence base for kyphoplasty is substantial. The FREE trial, a randomised controlled trial, found that balloon kyphoplasty improved pain, function and quality of life compared with non-surgical care in the early period after fracture. For cancer-related fractures, the CAFE trial showed meaningful benefit over non-surgical management. Meta-analyses comparing kyphoplasty and vertebroplasty generally find both relieve pain, with kyphoplasty associated with greater height restoration and a lower rate of cement leakage, at higher cost. As with all fracture augmentation, the overall picture — including the underlying bone disease — is what guides the decision.

Kyphoplasty is generally well tolerated. The main technical risk is cement leakage, which is less common than with vertebroplasty because the cavity allows more controlled cement delivery, but can still occur. Because the bone is weakened by osteoporosis, further fractures can develop at other levels over time — a reflection of the disease rather than the procedure. For that reason, assessing and treating bone health, guided by the appropriate specialists, is an essential part of care alongside treating the fracture itself.

Where kyphoplasty is being considered, the decision rests on the fracture type and age, the degree of collapse and deformity, the severity of pain, and the response to non-surgical care. The procedure, its realistic benefits and its limitations are set out honestly and individually, alongside alternatives including vertebroplasty and continued non-surgical management, and alongside proper attention to bone-health treatment.

• —Wardlaw D, et al. Balloon kyphoplasty versus non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 2009. (PMID 19246088)
• —Berenson J, et al. Balloon kyphoplasty versus non-surgical management for painful vertebral fractures in cancer patients (CAFE): a randomised controlled trial. Lancet Oncol 2011. (PMID 21333599)
• —Ma XL, et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral fractures: a meta-analysis. Eur Spine J 2012. (PMID 23428914)
• —Zhang H, et al. Kyphoplasty versus vertebroplasty for osteoporotic vertebral fractures: systematic review and meta-analysis. J Orthop Surg Res 2018. (PMID 30348192)
• —Zhan Y, et al. Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis. World Neurosurg 2017. (PMID 28192270)
• —Taylor RS, et al. Balloon kyphoplasty for vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 2007. (PMID 17277923)