Kyphoplasty (Balloon Kyphoplasty)
Kyphoplasty (balloon kyphoplasty) is a minimally invasive surgical technique for painful vertebral compression fractures in which a balloon is placed percutaneously into the fractured vertebral body and inflated to create a cavity, after which bone cement (usually PMMA) is injected to stabilize the spine. It is most often used for osteoporotic compression fractures.
Ultimo aggiornamento: 2026-06-09
Definition
Kyphoplasty is a technique in which a collapsed vertebral body is reached through a small percutaneous skin entry, and a balloon catheter is placed inside and inflated to create a controlled cavity. The balloon opens a cavity within the collapsed vertebra and aims to restore some height; after it is removed, bone cement (often polymethylmethacrylate, PMMA) is injected into the cavity under low pressure. The cement hardens to stabilize the fracture. The method differs from vertebroplasty, in which cement alone is injected, by first creating a cavity with a balloon.
Indications
Kyphoplasty is considered for painful vertebral compression fractures, most often osteoporotic, that are demonstrated on imaging and concordant with clinical findings. It is generally offered to patients who have not responded to an adequate trial of conservative treatment (analgesics, bracing, activity modification) or who are at risk of complications from immobility. It may also be used for selected tumor-related (metastasis, multiple myeloma) or traumatic fractures. Demonstrating that the fracture is recent and symptomatic (for example, with edema on MRI) is important for the decision.
Procedure
The procedure is usually performed under local anesthesia with sedation or general anesthesia, with the patient prone. Under fluoroscopic (imaging) guidance, a fine cannula is advanced into the target vertebral body via a transpedicular or extrapedicular route. A balloon catheter is introduced through the cannula and inflated in a controlled manner to create a cavity within the vertebra. After the balloon is deflated and removed, bone cement is injected into the cavity under low pressure with imaging control. The cement is allowed to harden, the cannula is removed, and the small skin entry is closed.
Advantages and Limitations
Kyphoplasty is a minimally invasive procedure performed through a small skin entry and may allow early mobilization in many patients. Creating a cavity with the balloon may permit more controlled cement placement at relatively low pressure, which in some series has been associated with a lower rate of cement leakage. However, the method does not guarantee full correction of spinal alignment or height loss. It may be unsuitable in marked instability, spinal cord or nerve compression, retropulsion of a fracture fragment into the canal, or active infection; such cases may require open surgery.
Recovery and Risks
Recovery time varies by patient and underlying condition; many patients mobilize relatively quickly. Possible risks include leakage of bone cement into adjacent structures or into a vessel, nerve or spinal cord injury, infection, bleeding, new fractures in adjacent vertebrae, and rarely cement embolism. Pain may not resolve completely or may partly persist. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, bone quality, imaging findings, and expectations together.
Riferimenti
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1213-1215.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2767-2769.
- Steinmetz MP, Berven SH, Benzel EC, eds. Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management. 5th ed. Elsevier; 2022:514-517.
- NICE Technology Appraisal Guidance TA279 — Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. 2013.
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