Kyphoplasty is a minimally invasive medical procedure developed to treat painful vertebral compression fractures (VCFs), which often result from osteoporosis, trauma, or cancer. The technique involves using a balloon to create a cavity within the collapsed spinal bone, which is then filled with medical-grade cement to stabilize the fracture and restore vertebral height. While generally safe and effective, not all patients who have sustained a VCF are appropriate candidates for this treatment. The decision to proceed depends heavily on the specific nature of the fracture and the patient’s overall health status, as certain medical and structural conditions can make the procedure unsafe or ineffective.
Spinal Instability and Neurological Compromise
Fractures that involve the posterior wall of the vertebra, such as burst fractures, are typically considered non-candidates for kyphoplasty. In these cases, the integrity of the posterior bony structure is compromised, and bone fragments may be pushed backward into the spinal canal (retropulsion). Attempting the procedure carries a significant risk of cement leakage into the spinal canal or surrounding neural structures. Furthermore, inflating the balloon during kyphoplasty could potentially dislodge retropulsed fragments further into the canal, worsening structural damage.
Patients presenting with symptomatic myelopathy (spinal cord compression) or radiculopathy (nerve root compression) are also generally excluded. Kyphoplasty is a stabilization procedure and cannot achieve the surgical decompression required to remove pressure from compressed nerves or the spinal cord.
Another structural limitation is a near-total collapse of the vertebral body, often called vertebra plana, where the bone has lost more than 75% of its original height. In such cases, there is insufficient residual bone volume to allow for meaningful restoration of vertebral height or adequate cement containment. These severe, unstable fractures often require traditional open surgery, which allows for direct decompression of the spinal cord and internal stabilization with instrumentation like rods and screws.
Acute Systemic Health Risks
Active systemic infections, such as bacteremia or sepsis, are absolute contraindications because injecting cement into an infected area risks contaminating the cement itself. This contamination could create a persistent, infected foreign body (the cement), which is difficult to treat with antibiotics alone.
Localized spinal infections, including osteomyelitis (bone infection) or discitis (disc space infection), must be completely treated before any bone augmentation procedure can be considered. Uncorrected coagulopathies (unmanageable bleeding disorders or the use of high-dose blood thinners) also preclude the procedure, as these conditions significantly increase the risk of uncontrolled bleeding during the surgery.
Patients experiencing severe cardiopulmonary comorbidities, such as unstable heart or lung failure, face heightened risks. The procedure carries a risk of cement or marrow embolism, where material enters the bloodstream and travels to the lungs or heart. Therefore, severe medical conditions that make general anesthesia or moderate sedation unsafe must be stabilized before elective spinal intervention. An absolute exclusion is a known allergy to the polymethylmethacrylate (PMMA) bone cement or the contrast agents used to guide needle placement.
Fracture Chronicity and Pain Diagnosis
The timing and certainty of the pain diagnosis are important factors in determining eligibility. Kyphoplasty is most effective when treating acute or subacute VCFs, typically those that have occurred within the last three months. If a fracture is classified as chronic (older than six or twelve months), the bone has usually stabilized or healed in its compressed state.
In chronic cases, the procedure is unlikely to offer significant pain relief, as the pain source may be chronic spinal changes rather than the active fracture. It is necessary to confirm that the VCF is the actual cause of the patient’s back pain. If the pain is caused by other spinal issues, such as degenerative disc disease, facet joint arthritis, or spinal stenosis, kyphoplasty will not alleviate the symptoms.
If a patient is diagnosed with a VCF but is not experiencing pain, they are not considered a candidate. Kyphoplasty is primarily a treatment for intractable, severe pain that has not responded to conservative management, such as medication and bracing.