An effective ‘minimal invasive’ cement injection
treatment of back pain caused by a crushed vertebrae
Review of Kyphoplasty:
• Kyphoplasty is a low risk, minimally
invasive spinal surgery procedure
used to treat common painful and
progressive Vertebral body Collapses
or Fractures (VCFs) that typically go
• The VCFs may be caused by
osteoporosis or spread of tumour
to the vertebral body.
• The procedure involves the use of
a balloon to restore the vertebral
body’s height and shape, followed
by bone cement augmentation to
• The procedure is usually performed
as a daycase and under sedation or
• The goal of the procedure is to:
• minimise pain
• allow early mobilisation and hospital
• improve quality of life.
Benefits of Kyphoplasty:
• Kyphoplasty has several benefits:
• It is a minimally invasive procedure.
• It restores vertebral body height
with a low risk of cement leakage.
• It is well tolerated and associated with
statistically significant improvements in
pain and function
(published clinical data).
• Published clinical data also shows that
patients benefit as much as 2 years after
(most bene cial results if
performed within 6 months of symptom onset).
• Offers the additional benefit of restoring
vertebral height towards the pre-fracture
anatomy with restoration of normal spinal
balance, and therefore reduces the risk of
• This height restoration may, in turn,
improve lung mechanics and decrease
muscular and ribcage pain.
Kyphoplasty is appropriate when
1. Osteoporotic vertebral collapse causing
persistent activity limitations and
debilitating pain that has not responded
to standard medical treatment (e.g.
physiotherapy, analgesics, external bracing,
with or without bed rest).
2. Evidence of progression of vertebral
3. Presence of neoplasms or other bone
pathology causing persisting or progressive
pain, progressive bone destruction or
imminent risk of vertebral collapse.
Kyphoplasty is NOT appropriate
in patients with:
1. Spinal curvatures, (e.g. scoliosis or kyphosis)
due to causes other than osteoporosis.
2. Spinal stenosis or disc herniations with
nerve or spinal cord compression and loss
of neurological function not associated
with a collapse or fracture.
Referral Process (see flow chart):
If you suspect a patient has
suffered a vertebral fracture:
• Confirm fracture via x-ray and/or Magnetic
Resonance Imaging (MRI)
patients should undergo conservative
medical management for 6 weeks initially.
• If pain persists, then refer to local
Kyphoplasty specialists (see names of
clinicians) for assessment on the suitability
• Following the procedure, NICE
recommends that all patients are referred
for physiotherapy and management of their
- Postmenopausal > age 55
- Known osteoporosis
- Low weight
- Steroid use
- Height loss ≥ 2cms
- Refer for standing AP + Lateral x-ray
NO RESPONSE IN 6WEEKS
VCFAT CLINICALLY PAINFUL LEVEL?
Level of pain, disability,
High disability and/or
Pain score ≥ 4
Manage underlying osteoporosis
• Obtain DEXA to diagnose
• Add Calcium andVitamin D
• Add bisphosphonates
• Recommend dietary changes
Low disability and/or
Pain score ≤ 4
MRI + STIR
EVIDENCE OF OEDEMA?
If pain persists ≥ 2 weeks
- Consider repeat x-ray studies
looking for further collapse
- Another new fracture
- Alternative diagnosis
- Sudden onset acute
- Mechanical pain
improved lying flat
- Minimal / no trauma
or recent fall
- Height loss ≥ 2cms
- Thoracic hyperkyphosis
- Percussion tenderness over
fracture site (junctional areas)
- Flexion pain
• Pain management
• Physical therapy
• Open Surgery (if appropriate)
Alternative diagnosis, i.e. infection,
metastasis, inflammatory disorders,
All referrals to: Mr Khai Lam (Consultant Spinal Surgeon), and/or Dr Tarun
Sabharwal (Consultant Interventional Radiologist).Tel:
020 7234 2009