Spine Fracture / Kyphoplasty

A vertebral compression fracture (VCF) occurs when one or more bones of the spinal column — most commonly in the thoracic (mid-back) or lumbar (lower back) spine — crack and collapse under pressure. The vertebral body, the rectangular block of bone at the front of each spinal level, compresses or wedges, losing height. This collapse can be sudden (during a fall, a sneeze, or even lifting a light object) or gradual over time. VCFs are extremely common: approximately 1.5 million occur in the United States annually. Osteoporosis is by far the most common cause — when bone density falls below a critical threshold, everyday stresses can fracture vertebrae. Cancer metastases to the spine are another major cause, weakening the bone from within. VCFs cause severe, acute back pain that is dramatically worse with standing and walking, and is partially relieved by lying flat — a distinguishing feature from muscular back pain.

Both kyphoplasty and vertebroplasty are minimally invasive procedures that stabilize a fractured vertebra by injecting bone cement (polymethylmethacrylate, or PMMA) into the collapsed bone. The key difference is that kyphoplasty first uses an inflatable balloon — called a bone tamp — to create a cavity within the vertebra and partially restore the lost vertebral height before cement is injected. Vertebroplasty injects cement directly without the balloon step. Kyphoplasty’s balloon creates a contained low-pressure space for cement delivery, which reduces the risk of cement leakage outside the vertebra compared to the higher-pressure injection used in vertebroplasty. Kyphoplasty also offers the additional benefit of height restoration, which can improve spinal alignment and reduce the kyphotic (hunched) deformity that untreated compression fractures can cause over time.

The hallmark of a VCF is new-onset, severe mid or lower back pain that is dramatically worsened by standing, walking, or any axial loading — and noticeably improved by lying flat. Pain from a compressed vertebra is typically focal and reproducible with gentle percussion (tapping) over the affected spinal level. Unlike disc herniations or sciatica, most VCFs do not cause radiating leg pain unless there is also nerve involvement from retropulsed bone fragment. Risk factors include known osteoporosis, prior vertebral fractures, long-term corticosteroid use, and history of cancer. An X-ray showing vertebral height loss is often the first clue, but MRI is the gold standard — it identifies acute (fresh) fractures by showing bone marrow edema, which distinguishes a fracture requiring treatment from an old, healed collapse.

Kyphoplasty is performed under mild sedation or general anesthesia (either is appropriate) with the patient lying face-down. Using fluoroscopic guidance, Dr. Chahal advances a narrow hollow needle called a trocar through the skin and into the pedicle — a bony bridge connecting the back of the vertebra to the body — on both sides of the fractured vertebra. A small drill creates a channel, through which a deflated balloon tamp is passed. The balloon is slowly inflated, gently lifting the collapsed vertebral endplate and restoring height. This also compacts the surrounding cancellous bone, creating a contained cavity. The balloon is removed, and bone cement (PMMA) is carefully injected under continuous fluoroscopic visualization to fill the cavity. Cement hardens within 10–15 minutes, permanently stabilizing the fracture. The procedure typically takes 45–75 minutes, and most patients feel dramatic pain relief within hours of waking up.

Kyphoplasty is one of the most dramatically effective pain-relieving procedures in interventional radiology. Published randomized controlled trial data show that 90–95% of patients experience significant pain reduction — many reporting near-complete relief within 24–48 hours of the procedure. The mechanism is immediate: once the fractured bone is mechanically stabilized and can no longer micro-move with each breath or body weight shift, the pain generating from the fracture site resolves rapidly. In clinical trials (including the FREE trial comparing kyphoplasty to non-surgical management), kyphoplasty patients reported faster and more complete pain relief, greater mobility restoration, and improved quality of life scores at both short- and long-term follow-up compared to medical management alone.

Cement leakage — where PMMA escapes outside the vertebral body into adjacent structures — is the primary risk of kyphoplasty. However, kyphoplasty’s balloon-first technique creates a structured, low-pressure cavity that significantly reduces leakage risk compared to vertebroplasty. In published series, clinically significant cement leakage causing neurological symptoms occurs in under 1% of kyphoplasty cases. The procedure is performed under live biplane or C-arm fluoroscopy at all times, and cement injection is immediately halted at the first sign of extravasation. Cement leakage into the spinal canal causing cord injury is exceedingly rare when the procedure is performed by an experienced interventional radiologist with appropriate technique. Other rare risks include infection at the needle site (<0.5%) and pulmonary embolism from cement entering the venous system, again less than 1% in experienced hands.

Yes — and treating multiple levels simultaneously is frequently appropriate and common, particularly in osteoporotic patients who often present with two or three adjacent fractures. Clinical data show that multilevel kyphoplasty (treating 2–4 levels in one session) is safe, with no significant increase in complications versus single-level procedures. The decision to treat multiple levels depends on MRI confirmation of acuity (bone marrow edema confirming the fractures are recent and pain-generating) and overall procedure time and sedation duration. Dr. Chahal will review all imaging and clinical findings to determine which levels warrant treatment.

Kyphoplasty typically restores 35–70% of lost vertebral height, and this height restoration is permanent — the PMMA cement is stable and does not resorb or lose structural integrity over time. Height restoration is greatest when the procedure is performed within the first 6–8 weeks of the fracture, while the bone is still mobile enough to be re-expanded by the balloon. Fractures treated after this window may still benefit from excellent pain relief and stabilization but tend to show less height restoration as the bone has already begun healing in its compressed position. While kyphoplasty does not fully reverse established kyphotic deformity, it prevents further collapse and can modestly improve overall spinal alignment.

Adjacent-level fracture — where the vertebra immediately above or below the treated level subsequently fractures — is a legitimate concern and occurs in approximately 10–20% of patients over subsequent years. This is not caused by the kyphoplasty itself but reflects the underlying osteoporosis that made the first fracture possible. The adjacent vertebra was already at elevated risk before the procedure. Optimizing bone density treatment — initiating or adjusting bisphosphonates, denosumab, or anabolic agents like teriparatide — after kyphoplasty is strongly recommended and discussed at every post-procedure visit. Patients who address their underlying bone density proactively have meaningfully lower rates of subsequent fractures.

Yes. Kyphoplasty (CPT 22513–22515 for thoracic and lumbar levels) is covered by Medicare and the large majority of commercial insurance plans for acute vertebral compression fractures when appropriate clinical and imaging criteria are met — specifically, a painful fracture with MRI-confirmed bone marrow edema indicating an acute or subacute injury. Documentation of the underlying cause (osteoporosis confirmed by DEXA scan, or known malignancy) and a short trial of conservative management (typically 4–6 weeks for osteoporotic fractures, expedited for tumor-related fractures causing neurologic risk) is generally required. Our team manages prior authorization completely and works to expedite approval for patients with severe pain or progressive neurological involvement.