Kyphoplasty and vertebroplasty are surgical procedures used to treat compression fractures in the spine. Both versions use a cement-like substance to stabilize the fractured vertebrae, the bones that make up the spine. During a kyphoplasty, however, a balloon is also inflated within the bone to help restore its natural height and shape.
Both versions are usually very successful in alleviating fracture-related pain.
This article will detail the similarities and differences between these procedures and discuss what may lead a physician to recommend one type over the other.
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Kyphoplasty vs. Vertebroplasty for Spinal Fracture Repair
Over 1 million people in the United States experience a spinal compression fracture each year. This painful condition typically occurs after osteoporosis (a condition of decreased bone mineral density and bone mass) weakens the vertebral bones in the spine and causes them to fracture or collapse.
For people whose spinal fracture pain cannot be managed conservatively, a kyphoplasty or vertebroplasty is often recommended. The following sections compare and contrast these vertebral augmentation procedures.
Similarities
Both vertebroplasty and kyphoplasty are used to treat the pain caused by a vertebral fracture. Each of these procedures involves injecting a medical cement called polymethylacrylate (PMMA) into the fractured bones in the spine. This is performed using a needle called a trocar while the patient is lying on their stomach.
In addition, both kyphoplasty and vertebroplasty are typically performed while the patient is under moderate sedation (conscious sedation), similar to the type used in a colonoscopy. Finally, both procedures usually are followed by a computed tomography (CT) scan to confirm the placement of the cement in the vertebrae.
Differences
The primary difference between a vertebroplasty and a kyphoplasty is the balloon utilized during a kyphoplasty. While medical cement is used to stabilize fractured vertebrae in both procedures, the surgeon takes the added step of inflating a balloon inside the vertebrae during a kyphoplasty.
This helps restore height and form to the injured portion of the spine. In some cases, a titanium implant is used in place of a balloon when the surgeon tries to restore proper height to the vertebrae.
Risk Comparison
Both procedures are considered extremely safe, and side effects are relatively rare. While there is always a risk of complications when performing an injection near the spinal cord, the use of fluoroscopy adds precision and reduces the likelihood of an error.
Occasionally, the cement used during a kyphoplasty or vertebroplasty can leak into the surrounding areas. One study found this occurred in 25% of cases, though the incidence of symptoms from this complication is rare. In addition, there is some evidence suggesting that you are at a slightly higher risk of future vertebral body collapse if you choose a vertebroplasty over a kyphoplasty.
Treatment Outcomes
Kyphoplasty and vertebroplasty are both very effective procedures. One study found that the average person’s pain level dropped from 6.8 to 2.1 on a 10-point scale six weeks after a vertebroplasty.
For people undergoing a kyphoplasty, this number went from 7.1 to 2.0 at the six-week mark. A year after the procedures, both groups reported an average pain under 1 out of 10. In addition, 90% of people in the study were able to walk independently and without pain three months after the procedures.
Cost-Wise, How Do Kyphoplasty vs. Vertebroplasty Compare?
The costs of these two vertebral augmentation surgeries vary widely, depending on your location and individual insurance coverage. In general, however, kyphoplasty procedures are usually more expensive than vertebroplasty.
For example, the out-of-pocket cost of a kyphoplasty for a patient with Medicare is estimated to be between $770 and $1,455. The estimated Medicare out-of-pocket cost for a vertebroplasty, which is between $382 and $695.
To truly understand the cost differences, it is best to obtain an individualized quote from the hospital or surgical center where the procedure will take place.
Step-by-Step Kyphoplasty vs. Vertebroplasty Procedure
Kyphoplasty and vertebroplasty procedures are fairly similar and follow these steps:
- The patient is placed under anesthesia and is positioned on their stomach.
- Using a low-powered X-ray machine, called fluoroscopy, the physician inserts a needle through the skin and into the fractured vertebral body.
- If a kyphoplasty is being performed, a balloon is inserted and inflated to restore the height of the vertebrae. In a vertebroplasty, this step is skipped.
- Bone cement is injected through the needle into the vertebra or vertebrae to stabilize the fracture.
- After allowing the cement to harden for about 20 minutes, the incision is closed and the patient is taken to the recovery area for several hours before being discharged home.
Kyphoplasty vs. Vertebroplasty Recovery
Around 80% to 90 % of patients who undergo a kyphoplasty or vertebroplasty experience pain relief almost immediately after the procedure. Occasionally, there will be some soreness over the incision that persists for a few days afterward.
Patients recovering from both types of procedures are typically advised to maintain relative bed rest for 24 hours. Following this period, nonstrenuous activities can be resumed as long as they are not causing pain. More physical activities, like exercise or heavy lifting, should not be performed for at least six weeks after the procedure.
Deciding Between Kyphoplasty vs. Vertebroplasty
Due to its ability to restore vertebral height after a compression fracture, the kyphoplasty procedure is the more commonly performed variety. Occasionally, a vertebroplasty is more advantageous in situations in which a chronic spinal fracture does not permit a balloon to be inflated inside it.
Typically, the interventional radiologist or neuroradiologist who performs the procedure will complete an extensive examination before giving their recommendation.
This usually involves assessing your symptoms and ordering images of your spine to evaluate the fracture. While the decision on which type of procedure you undergo is ultimately your own, your surgeon or referring healthcare provider will be able to provide you with the pros and cons of each option.
Summary
Kyphoplasty and vertebroplasty are surgeries that are used to treat compression fractures in the spine. Both procedures stabilize the fractured area using bone cement that is inserted with a needle into your vertebrae.
In a kyphoplasty, a balloon is also inflated inside the vertebrae to help restore its prior height and shape. Both surgeries effectively alleviate pain in the large majority of individuals and have a relatively low incidence of side effects.
