Kyphoplasty and Vertebroplasty (Bone Cementing) for Spine Fractures
Overview
Kyphoplasty and vertebroplasty are minimally invasive spine procedures used to treat painful vertebral compression fractures, most commonly caused by osteoporosis, trauma, or tumors. Both techniques involve injecting bone cement into a fractured vertebra to stabilize it and relieve pain. While they share similar goals, they differ in technique and specific indications.
What is Vertebroplasty?
Vertebroplasty involves the percutaneous (through the skin) injection of medical-grade bone cement (usually polymethylmethacrylate) directly into the fractured vertebral body using special needles. The cement hardens quickly, stabilizing the fracture and alleviating pain.
What is Kyphoplasty?
Kyphoplasty is an advanced variation of vertebroplasty. It involves the insertion of an inflatable balloon into the fractured vertebra. This balloon is gently inflated to create a cavity and attempt to restore lost vertebral height. Once the desired space is created, the balloon is removed, and the cavity is filled with bone cement.
Kyphoplasty offers several advantages:
- Restores collapsed vertebral height – helping to correct kyphotic (hunched) posture.
- Reduces cement leakage – the balloon creates a controlled cavity with a bony shell, which helps contain the cement.
- Allows more cement to be used – improving support in severely collapsed vertebrae.
How Does Bone Cement Help?
- Stabilizes the fracture and prevents further bone collapse
- Reduces nerve irritation from moving bone fragments
- Restores spine strength
- Improves posture in cases with collapsed bones
- Offers quick pain relief, usually within hours
- Minimizes need for open surgery
Indications for Vertebroplasty and Kyphoplasty:
1. Osteoporotic Vertebral Compression Fractures (VCFs):
These are the most common indications. Cement injection provides internal structural support and relieves pain almost immediately.
Benefits include:
- Rapid pain relief
- Improved mobility and quality of life
- Prevention of further vertebral collapse, which can lead to:
- Increased pain
- Progressive kyphotic deformity
- Risk of spinal cord compression from displaced fragments
In mild to moderate compression fractures, vertebroplasty is often sufficient. In severely collapsed vertebrae or those with significant height loss, kyphoplasty is preferred due to its ability to restore vertebral body height.
In unstable or multi-level fractures, these procedures may be combined with spinal instrumentation (screws and rods) for additional structural support.
2. Spinal Tumors (Metastatic or Primary):
Vertebroplasty or kyphoplasty can be performed as palliative procedures in patients with vertebral body collapse caused by spinal tumors. The goal is pain relief and spinal stabilization.
These procedures are often combined with spinal fixation surgery to support the spine and prevent progression of deformity or instability due to tumor-related bone destruction.
3. Osteoporotic Spine Instrumentation Support:
In patients with severe osteoporosis, the grip of pedicle screws in the bone is often poor, leading to risk of screw loosening or implant failure.
Performing vertebroplasty at the intended screw-insertion levels just before placing screws can:
- Improve screw hold
- Increase construct stability
- Reduce the chance of implant loosening over time
Potential Complications:
1. Cement Leakage:
The most common complication. Leakage of cement outside the vertebral body, especially into the spinal canal, can compress the spinal cord or nerves, causing new neurological symptoms.
Key points to minimize risk:
- Wait 2–3 weeks after an acute fracture before performing vertebroplasty. This allows fracture clefts to seal and reduces the risk of cement leakage.
- Kyphoplasty has a lower risk of leakage due to the controlled cavity created by balloon inflation and the surrounding bony shell.
2. Progressive Collapse of Remaining Vertebral Body:
In cases of severe osteoporosis, only the fractured part of the vertebra gets filled with cement, leaving the rest vulnerable. Over time, this unfilled portion may collapse.
Prevention:
Combining vertebroplasty with spinal instrumentation in severely osteoporotic or unstable fractures can prevent progressive collapse.
3. Fracture of the adjacent Vertebrae:
As the vertebra with bone cement in it becomes very hard, it can potentially cause significant pressure on surrounding vertebral bodies above and below it. This can cause fracture of these adjacent vertebral bones.
Also, other vertebrae can collapse due to primary pathology (Osteoporosis/ metastatic tumor) which lead to fracture collapse of the vertebra being treated now. Hence, it is important to treat primary pathology also after treating the fractured vertebra.
4. Allergic Reaction:
Though rare, some patients can develop an allergic reaction to the cement components leading to drop in blood pressure and other side effects related to heart. Gradual cementing reduces this risk. If it happens, anesthesia team usually can take care of the potential side effects.
5. Pulmonary Embolism
This is extremely rare complication which happens if cement enters blood vessels, or of it pushes fat globules from the vertebral body into the circulatory system. This complication can be potentially dangerous causing problem with respiratory and circulatory system.
Advantages of Kyphoplasty Over Vertebroplasty:
Feature | Kyphoplasty | Vertebroplasty |
|---|---|---|
Cement leakage risk | Lower | Higher |
Vertebral height restoration | Possible | Not possible |
Cement fill volume | More | Less |
Cost | Higher | Lower |
Kyphoplasty is preferred in:
- Severely collapsed vertebrae
- Cases requiring vertebral height restoration
- Patients with significant kyphotic deformity
However, it is not mandatory in every fracture case. The decision depends on fracture type, collapse severity, patient’s overall condition, and cost considerations.
Conclusion
Both kyphoplasty and vertebroplasty are highly effective, minimally invasive procedures for treating painful vertebral fractures. They significantly improve pain, mobility, and quality of life, especially in elderly osteoporotic patients. While vertebroplasty is simpler and more cost-effective, kyphoplasty offers added benefits in selected cases, such as height restoration and reduced risk of cement complications.
Consultation with a spine surgeon is essential to determine the most appropriate procedure based on the fracture pattern, imaging findings, and patient-specific factors.
Frequently Asked Questions (FAQs)
Kyphoplasty refers to a surgical procedure designed to stabilize a fractured vertebra using bone cement. The name combines “kypho-,” indicating curvature of the spine, and “-plasty,” meaning surgical repair. The goal of kyphoplasty is to reduce pain, stabilize the spine, and, when possible, restore the normal height and alignment of the vertebra affected by a compression fracture.
The cost of balloon kyphoplasty can vary significantly depending on the location, hospital, surgeon’s expertise, and the number of vertebral levels treated. In India, the cost typically ranges from ₹1.5 lakhs to ₹3 lakhs per level. This usually includes the balloon device, cement kit, surgical fees, imaging, hospital stay, and post-operative care. Additional costs may apply for advanced imaging or extended hospitalization.
Bone cement, commonly used in kyphoplasty and vertebroplasty, is generally safe but can cause side effects in rare cases. Potential risks include cement leakage, which might irritate spinal nerves; allergic reaction to the cement material; infection; and very rarely, pulmonary embolism if cement enters the bloodstream. Adjacent vertebral fractures can also occur due to altered spinal load distribution after the procedure.
Recovery after kyphoplasty is usually quick. Most patients can walk within hours after the procedure and are discharged the same day or within 24 hours. Light activities can be resumed within 2–3 days, while complete recovery typically takes 2–4 weeks. Patients are advised to avoid heavy lifting and follow bone-strengthening measures, especially in cases of underlying osteoporosis.
Yes, kyphoplasty is particularly effective for osteoporotic compression fractures that cause severe back pain and limit mobility. It provides immediate pain relief, stabilizes the spine, and reduces the risk of further vertebral collapse. Since the procedure is minimally invasive, it is ideal for elderly patients and those with poor bone health. It is also effective in selected cases of cancer-related vertebral collapse or traumatic fractures.
The balloon in balloon kyphoplasty serves two primary functions: restoring vertebral height and creating a cavity for controlled cement injection. By inflating the balloon inside the collapsed vertebra, the procedure can partially correct spinal deformity and reduce kyphotic angulation. The space created by the balloon allows for safer and more effective cement placement, lowering the chances of leakage and improving outcomes.
While both procedures aim to relieve pain and stabilize the spine, kyphoplasty often results in better spinal height restoration and alignment correction due to the use of a balloon. Recovery timelines are similar, with most patients resuming daily activities within a few days. However, kyphoplasty is associated with a slightly lower risk of cement leakage and may offer improved functional outcomes, especially in patients with severe vertebral collapse.
Cement injection, used in both vertebroplasty and kyphoplasty, is highly effective for treating painful vertebral compression fractures. The cement hardens quickly, stabilizing the fractured vertebra and significantly reducing pain. Studies show that up to 90% of patients experience rapid and lasting pain relief. The technique also allows early mobilization, which is critical in elderly patients to prevent complications related to immobility.
