Kyphoplasty — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Balloon kyphoplasty (BKP) is a minimally invasive percutaneous spinal procedure designed to stabilise painful vertebral compression fractures (VCFs) and restore vertebral body height lost due to fracture collapse. It is most commonly performed for osteoporotic VCFs — one of the most prevalent and debilitating complications of osteoporosis, affecting approximately 1.4 million patients annually worldwide. Unlike open spinal surgery, kyphoplasty is performed through small skin punctures under fluoroscopic X-ray guidance. The distinguishing feature of kyphoplasty versus simple vertebroplasty is the use of an inflatable bone tamp (balloon) to create a cavity within the collapsed vertebra before cement injection — this partially restores vertebral height (a unique capability over vertebroplasty), reduces spinal kyphosis deformity, and allows injection of viscous cement at low pressure into the pre-formed cavity, reducing cement extravasation. The procedure is performed under local anaesthesia with sedation in most patients (allowing same-day discharge) or under general anaesthesia when multiple levels are treated simultaneously. Kyphoplasty is distinct from, and not appropriate for, unstable burst fractures, posterior element fractures, or fractures requiring decompression of the neural canal — these require conventional spinal surgery.

Patient selection for kyphoplasty requires careful clinical and radiological assessment. Appropriate candidates are patients with: acute or subacute osteoporotic or cancer-related vertebral compression fractures (typically T4–L5) causing significant pain (VAS score ≥5/10) that has not responded adequately to 4–6 weeks of conservative management including analgesics, bracing, and physiotherapy; MRI-confirmed signal changes in the fractured vertebra (bone marrow oedema on STIR sequences) indicating the fracture is acute or subacute and potentially mobile rather than old and consolidated (healed fractures do not benefit from cement augmentation); stable neurological examination without spinal cord or nerve root compression; and adequate bone density or pathological fracture from metastatic disease where vertebral consolidation can improve mobility and pain control in palliative oncology patients. Contraindications include: active spinal or systemic infection; uncorrectable coagulopathy; spinal cord compromise from retropulsed fragments in the spinal canal; severe collapse with less than 20% residual vertebral height (insufficient space for balloon inflation); and allergy to cement components. Patients with multiple myeloma involving the vertebra may benefit from kyphoplasty as part of multimodal disease management.

Kyphoplasty is performed in a fluoroscopy suite or operating theatre with the patient prone on a padded spinal frame. AP and lateral fluoroscopic views confirm the target vertebra and identify safe access trajectories. Under local anaesthesia with sedation, small (approximately 5 mm) stab incisions are made bilaterally in the back over the target level. Bilateral transpedicular trocars are advanced under continuous fluoroscopic guidance through the pedicle cortex and into the posterior third of the vertebral body — the transpedicular route protects the neural structures throughout. Through each trocar, a specially designed drill creates a channel in the collapsed cancellous bone. Balloon bone tamps (inflatable curettes) are inserted bilaterally through the working channels. The balloons are slowly inflated under continuous pressure monitoring (typically 200–300 PSI) and radiographic guidance — inflation gradually elevates the collapsed end plates, partially restoring vertebral height and creating a well-defined cavity. The balloons are then deflated and removed. Low-viscosity polymethylmethacrylate (PMMA) bone cement, mixed to a toothpaste consistency, is injected in small aliquots under constant fluoroscopic monitoring to fill the cavity completely while avoiding extravasation. The trocars are removed and the small wounds are dressed. The procedure is repeated for each fractured level; bilateral approach at a single level takes approximately 45 minutes.

Kyphoplasty provides rapid and durable pain relief in the majority of patients with acute osteoporotic VCFs. Multiple prospective trials and the landmark FREE trial (Fracture Reduction Evaluation) demonstrated significantly greater pain relief, functional improvement, and quality of life restoration with kyphoplasty compared to non-surgical management at 1 month (VAS reduction of 5 versus 2 points) with benefit maintained at 24 months. Over 90% of patients experience significant pain reduction within 24–48 hours of the procedure — often dramatically so, allowing rapid mobilisation and reduction in opioid analgesic requirements. Vertebral height restoration averages 34–50% of lost height in acute fractures (greater in more acute fractures), with corresponding improvement in regional kyphosis angles of 8–14 degrees in published series. Restoration of height and alignment reduces long-term adverse biomechanical loading on adjacent vertebrae. Health-related quality of life (HRQoL) scores — including SF-36 and EQ-5D — improve significantly after kyphoplasty compared to conservative management. For cancer-related vertebral fractures (myeloma, breast and lung metastases), kyphoplasty reduces pain to allow dose reduction of opioid analgesia and improves mobility and independence in the palliative setting.

Kyphoplasty is a minimally invasive procedure with an overall complication rate of 2–8%, considerably lower than open spinal surgery. Cement extravasation (leakage outside the intended vertebral cavity) is detectable on imaging in 10–40% of cases but is symptomatic and clinically significant in only 1–3%. Cement can extravasate paravertebrally (usually benign), into the disc space (may accelerate adjacent disc degeneration), or into the epidural space (potentially causing nerve compression or, rarely, spinal cord compression requiring urgent decompression). The balloon kyphoplasty technique — with pre-formed cavity and higher viscosity cement — significantly reduces clinically significant cement extravasation compared to vertebroplasty. Cement pulmonary embolism from venous extravasation is rare (under 0.5%) but potentially serious; minor asymptomatic cement migration to the lungs is detectable in a small proportion on post-procedure imaging. Adjacent level fractures are a concern: approximately 15–20% of patients develop a fracture at an adjacent vertebra within 12 months of kyphoplasty — this likely reflects the underlying osteoporosis rather than the kyphoplasty itself, as similar rates are seen after conservative management. Infection (discitis, spondylodiscitis) is very rare (under 0.1%) with appropriate sterile technique. Neurological injury is rare (under 0.3%) and most often related to incorrect pedicular approach trajectory.

The majority of patients are ambulatory within 2–4 hours of the procedure and may be discharged home the same day. Pain relief is often experienced as immediate or within the first 24–48 hours as the cement provides structural stability to the fractured vertebra. Mild post-procedural discomfort at the puncture sites is managed with paracetamol and NSAIDs. Light activities such as walking, self-care, and short journeys resume within 1–2 days. Sedentary work (office-based or similar) can resume within 1–2 weeks. Lifting of objects greater than 5 kg, bending, twisting, and sustained forward flexion are avoided for 6 weeks. A lumbar support brace may be prescribed for 4–6 weeks during activities. The most important aspect of aftercare is treatment of the underlying osteoporosis — kyphoplasty stabilises the acute fracture but does not address the systemic skeletal fragility that caused it. DEXA bone density scanning and anti-osteoporotic pharmacotherapy (bisphosphonates, denosumab, romosozumab) should be initiated or optimised by an endocrinologist or metabolic bone physician. Calcium and vitamin D supplementation, fall prevention assessment, and physiotherapy for balance and core strengthening are essential components of comprehensive fracture prevention. Follow-up imaging at 6–12 weeks confirms cement stability and evaluates for adjacent level involvement.