Kyphoplasty (Vertebral Augmentation)

What it is

Kyphoplasty, also called balloon kyphoplasty or vertebral augmentation, is a minimally invasive spinal procedure designed to stabilize a vertebral compression fracture: a crack or collapse of one of the bony building blocks of the spine. During the procedure, a small balloon is inserted into the fractured vertebra, carefully inflated to create a cavity and partially restore vertebral height where possible, and then filled with bone cement (polymethylmethacrylate, or PMMA) to hold the structure in place after the balloon is removed.

The primary goals are pain relief and mechanical stabilization. Where collapse is recent enough, the balloon inflation may partially correct the deformity before the cement hardens. Kyphoplasty is distinguished from vertebroplasty, a related technique, in that vertebroplasty injects cement directly without the balloon-preparation step. Both procedures fall under the broader term vertebral augmentation.

Who it helps

Kyphoplasty is considered for patients who have a painful vertebral compression fracture that has not responded adequately to conservative care (typically several weeks of rest, analgesic medication, and, in some cases, a supportive brace) and where imaging confirms the fracture is relatively recent (acute or subacute) rather than long healed.

The most common underlying cause is osteoporosis, which progressively weakens bone and makes it susceptible to fracture with minimal or no trauma. Vertebral compression fractures also occur in the setting of cancer that has spread to the spine (metastatic disease) and, less commonly, from significant trauma or other metabolic bone conditions.

Not every compression fracture is an appropriate indication. A careful evaluation (including MRI to assess fracture age, edema, and stability, together with assessment of overall health) guides the decision. Situations that are generally not suitable include fractures that are old and fully healed, fractures with significant spinal canal compromise producing neurological deficits, and active spinal infection. The evaluation will clarify whether kyphoplasty, ongoing conservative management, or a different intervention is the most appropriate path for each individual.

How it's performed

Kyphoplasty is typically performed on an outpatient or short-stay basis, under either monitored sedation with local anesthesia or general anesthesia, depending on patient factors and surgeon preference.

Using continuous fluoroscopic (real-time X-ray) guidance, the surgeon makes one or two small incisions in the skin of the back and advances thin working cannulas through the soft tissue and into the affected vertebra. A small, deflated balloon (the balloon tamp) is then passed through each cannula and carefully inflated within the collapsed bone. This inflation creates a contained cavity inside the vertebra and, when the fracture is recent enough and bone quality permits, may partially restore height and reduce the forward-bend deformity (kyphosis) associated with the collapse.

The balloon is deflated and removed, leaving the cavity in place. Bone cement (PMMA) is then slowly injected under continuous fluoroscopic surveillance to fill the cavity and consolidate the fracture. The cement hardens within minutes, providing immediate mechanical support. The cannulas are withdrawn and the small skin punctures are typically closed with a single suture or adhesive strips. The entire procedure generally takes under an hour when a single level is treated.

Recovery

Most patients are able to stand and walk within a few hours of completing the procedure. When performed on an outpatient basis, discharge typically occurs on the same day or the following morning.

Pain improvement, when it occurs, may be noticeable within the first one to several days, though the degree and timing of relief vary among individuals and cannot be predicted in advance. A back brace may be recommended for a defined period following the procedure, based on fracture characteristics and surgeon judgment.

Physical therapy focused on gentle mobility, posture, and progressive core conditioning is often introduced once the acute phase has passed. It is equally important to address the underlying cause of the fracture, particularly osteoporosis, with appropriate medical management, since stabilizing one vertebra does not protect the remaining vertebrae from future injury.

Strenuous lifting, bending, and impact activities are typically restricted for several weeks following the procedure. Return to activities is guided by individual progress and physician direction.

Risks & considerations

Kyphoplasty is generally considered a low-risk procedure, but it carries potential complications that every patient should understand before proceeding.

Cement leakage is the most commonly discussed concern. Small amounts of cement may escape outside the boundaries of the vertebra into adjacent structures. The majority of such leaks are asymptomatic and detected only on imaging. However, cement that migrates into the spinal canal, around nerve roots, or into venous structures can, in uncommon circumstances, cause pain, neurological symptoms, or, in rare cases, a cement pulmonary embolism.

Adjacent-level fractures have been observed following vertebral augmentation. Whether the procedure itself increases this risk above the baseline risk associated with osteoporotic spine disease is a topic of ongoing discussion in the literature; regardless, new fractures at neighboring vertebrae are a recognized concern in this patient population.

Infection is a potential risk with any procedure that penetrates the skin and spine, though it is uncommon.

Incomplete pain relief is a realistic possibility. Not all patients experience meaningful reduction in pain after kyphoplasty, and the procedure is not appropriate as a treatment for diffuse back pain unrelated to a confirmed acute fracture.

Anesthesia-related risks apply as with any operative procedure and should be discussed with the anesthesia team.

Kyphoplasty addresses the structural consequences of a fracture at a specific level but does not treat the bone disease that caused it. Patients with osteoporosis are strongly encouraged to engage with appropriate specialist care, including evaluation for bone-density treatment, to reduce the risk of fractures at other levels.