Kyphoplasty: Procedure & Benefits
Kyphoplasty is a minimally invasive procedure used to treat painful vertebral compression fractures, often caused by osteoporosis or trauma. By stabilizing the fractured vertebra and restoring spinal height, this technique helps reduce pain, improve mobility, and enhance patients’ quality of life. In this article, we will review the procedure, its benefits, and clinical applications.
What is Kyphoplasty?
Kyphoplasty is a procedure to treat vertebral compression fractures, which are generally caused by osteoporosis. When a vertebra fractures, the resulting bone fragments undergo a sliding motion, generating friction and potential harm to the spinal canal, nerve roots, or spinal cord. This detrimental process gives rise to pain, weakness, and in severe cases, limb paralysis. Kyphoplasty represents an effective treatment modality for addressing this condition, as it restores the height of the vertebral body and stabilizes it with a cement-like substance.
In this approach, the surgeon inserts a hollow needle called a trocar through the skin into the vertebral body using image guidance (fluoroscopy). The fracture site is then expanded with a balloon, after which a cement mixture is injected into the bone. This leads to:
- restoring vertebral height
- improving spinal alignment
- reducing abnormal forces applied to the vertebrae
- lowering the risk of future fractures
- relieving pain
Treatment Methods for Spinal Compression Fractures
Vertebral fractures are the most common fractures caused by osteoporosis. In addition to back pain, spinal compression fractures can cause spinal deformity and reduced mobility. Some of the prescribed modalities for managing these fractures include bed rest, physical therapy, and the use of braces. However, in certain cases, non-surgical interventions may be insufficient to relieve the patient’s pain, making surgical treatment necessary. Among the minimally invasive spine surgery techniques, kyphoplasty is widely recognized as an effective option.
How is Kyphoplasty Performed?
The main steps of the kyphoplasty procedure are as follows:
Step 1: Patient Preparation
Diagnostic tests such as blood work, imaging (X-ray, CT, or MRI), and bone densitometry may be performed to confirm the vertebral fracture and evaluate the patient’s overall condition before surgery. On the day of the procedure, depending on the location of the compressed vertebra (cervical, thoracic, or lumbar), the patient’s back or neck is disinfected and prepared. The patient then lies on the operating table, and regional or general anesthesia is administered.
Step 2: Trocar Insertion
A trocar is inserted into the vertebral body under fluoroscopic guidance to ensure accurate positioning. To avoid contact with the spinal cord, the trocar is angled carefully and advanced into the vertebra, sometimes with gentle tapping using a mallet if needed.
Step 3: Restoring Vertebral Height with a Balloon
Through the trocar, a balloon is inserted into the vertebral body. A drill may be used to create a pathway before the balloon is advanced. The balloon is then gradually inflated, elevating the collapsed vertebra and helping restore its height. Afterward, the balloon is deflated and removed, leaving a cavity for cement injection.
Step 4: Injection of Bone Cement
Bone cement is slowly injected into the vertebral cavity. The amount and pressure are carefully controlled to prevent leakage, while continuous X-ray imaging ensures precise placement.
Step 5: Final Step
Once the cement is in place, the trocars are removed before it hardens. Because the incision is very small, sutures are usually unnecessary. Instead, the site is closed with dressing or skin tapes.
Top Players in the Kyphoplasty Set Market
Several major companies dominate the global kyphoplasty set market, providing advanced products and technologies that support minimally invasive spine surgery. The key players include:
- Johnson & Johnson
- Joimax GmbH
- Teknimed
- Globus Medical
- Stryker Corporation
Asia Jarah Pishro Company offers kyphoplasty tool sets in three models to medical centers:
What is the Difference Between Kyphoplasty and Vertebroplasty?
Both kyphoplasty and vertebroplasty are effective in treating vertebral compression fractures and relieving pain, but they differ in technique and outcomes. Vertebroplasty involves injecting bone cement through the skin into the spongy bone of the vertebral body to relieve pain, prevent further loss of vertebral height, and reduce the risk of spinal cord damage. Kyphoplasty, on the other hand, uses a balloon to restore vertebral height, improve spinal alignment, relieve pain, stabilize the bone, and reduce kyphosis. In both procedures, imaging guidance (usually fluoroscopy) is essential.
Biomechanical studies have shown that kyphoplasty offers advantages over vertebroplasty in restoring vertebral height and improving kyphosis. Moreover, because of the balloon expansion that creates additional space, the risk of cement leakage is lower in kyphoplasty.
Nevertheless, both techniques provide significant pain relief and have a low rate of complications. Therefore, both kyphoplasty and vertebroplasty are considered safe and effective treatment options for managing vertebral compression fractures.
What is Bone Cement and What Materials is it Made of?
Bone cements are biomaterials made by combining a powder and a liquid component. These cements can be shaped and injected into the body as a paste. Bone cement can be used to fill cracks in the bone or gaps between implants and bone. Its injectability has greatly expanded its use in minimally invasive surgical techniques, making it widely applied in various orthopedic procedures.
Several materials can serve as bone cements or fillers. For many years, polymethyl methacrylate (PMMA) has been the primary choice in orthopedics. This biocompatible polymer offers favorable mechanical properties and is easily visible on X-ray, making it highly suitable as the main ingredient in bone cement. Viable alternatives to PMMA with similar biomechanical properties include calcium sulfate and calcium phosphate.
Advantages of Kyphoplasty
Kyphoplasty offers several benefits, including:
- Filling the pores caused by osteoporosis, thus augmenting bone integrity and reducing the likelihood of re-fracture
- Restoring vertebral height
- Relieving pain and improving mobility, usually within 48 hours after surgery
- Within a few weeks after surgery, about two-thirds of patients can significantly reduce their use of pain medication
Possible Risks of Using the Kyphoplasty Technique
Kyphoplasty is a safe and effective surgical procedure, but like any surgery, it can be associated with potential complications, including:
- infection
- Bleeding
- Anesthesia-related complications
- Persistent back pain
- Tingling, numbness, or weakness due to nerve or spinal cord injury
- Allergic reactions to chemicals used in X-ray imaging
- Leakage of cement into surrounding tissues, which may compress nerves or cause venous embolism
Depending on the patient’s overall health, additional risks may occur. For example, patients with osteoporosis may experience fractures in other vertebrae. To reduce this risk, physicians often prescribe medications to improve bone quality.
Use Cases of Kyphoplasty
Kyphoplasty is commonly recommended for individuals who experience persistent lumbar pain and limited mobility due to compression fractures caused by osteoporosis or pathological factors, such as bone marrow cancer, metastatic cancer, or benign vascular tumors. It is also used for elderly or frail patients who are too weak for open or reconstructive vertebral surgery.
In general, kyphoplasty is employed when conventional treatments such as rest, medical braces, physiotherapy, and pain medications have proven ineffective.
Certain conditions, including bone infections, spinal canal tumors, bleeding disorders, or drug sensitivities, make the patient unsuitable for this procedure.
Why is this Procedure Called Kyphoplasty?
This procedure is called kyphoplasty because it helps correct undesirable kyphosis, or forward curving of the spine.
Optimal Timing for Kyphoplasty
Kyphoplasty is ideally performed within 8 weeks of the fracture to maximize recovery.
Is Kyphoplasty Painful?
Patients may feel mild discomfort at the trocar insertion site, which usually subsides within a few days.
How Long Does Kyphoplasty Take?
The procedure typically takes 20 minutes to an hour. Most patients experience pain relief and improved mobility within 1 to 3 days after surgery.
How Long Does the Patient Stay in the Hospital After Kyphoplasty?
Patients undergoing kyphoplasty are usually discharged on the same day of the procedure or the following morning.
Does the Patient Need to Take Special Medications After Kyphoplasty?
Patients may be prescribed vitamins or medications to strengthen the bones and help prevent further spinal fractures.
Is it Necessary for the Patient to Use a Brace?
The attending physician will determine whether a brace is needed after kyphoplasty.
When Can the Patient Resume Exercise?
Patients are typically encouraged to start walking as soon as possible, often within an hour after the procedure. They should consult their surgeon about activities to avoid. Heavy exercise is generally discouraged for 4 to 6 weeks after surgery.
Does the Patient Need Rehabilitation or Physiotherapy?
Physiotherapy is usually not required after kyphoplasty.
Will the Patient Have Long-Term Limitations After Kyphoplasty?
There are no long-term restrictions following kyphoplasty.
Conclusion
Kyphoplasty is a minimally invasive and effective solution for managing vertebral compression fractures, offering rapid pain relief, structural restoration, and improved mobility. With a favorable safety profile and short hospital stay, it provides a valuable alternative for patients who are not suitable candidates for open surgery, while supporting faster recovery and better quality of life.