Kyphoplasty is a minimally invasive treatment designed to stabilize painful vertebral compression fractures (VCFs), most commonly caused by osteoporosis. The procedure uses a balloon to restore vertebral height before injecting bone cement into the fractured bone to provide immediate stabilization and pain relief. While highly effective for many patients, it is not a suitable option for everyone suffering from a VCF. Determining the appropriate candidate requires a thorough evaluation of the patient’s overall health, the presence of any active diseases, and the specific characteristics of the spinal fracture itself.
Acute Conditions That Prevent Surgery
The presence of an active infection is one such clear contraindication, whether it is a systemic infection like bacteremia or a localized spinal infection such as osteomyelitis. Injecting foreign material like bone cement (polymethylmethacrylate, or PMMA) into an infected area can trap the bacteria, making the infection extremely difficult to eradicate.
Another significant acute barrier is an uncontrolled bleeding disorder, also known as uncorrectable coagulopathy. Kyphoplasty involves inserting needles and instruments into the vertebral body, and uncontrolled bleeding could lead to a spinal hematoma. This accumulation of blood near the spinal cord or nerve roots could cause severe neurological damage. Patients who cannot temporarily stop taking blood-thinning medications are not candidates.
The procedure is also contraindicated for individuals with a confirmed allergy to the bone cement itself or to the contrast dye used during the procedure. The cement contains components that can trigger a severe allergic response in hypersensitive individuals.
Characteristics of the Fracture That Rule Out Kyphoplasty
If a fracture is very old, considered to be beyond three to six months, the bone may have already healed or stabilized in its compressed state. In these chronic fractures, the ability of the balloon to restore vertebral height is significantly diminished, reducing the potential benefit of the procedure. Similarly, VCFs that are stable and not causing any pain or functional limitation do not require surgical intervention.
Kyphoplasty is also inappropriate for fractures that are mechanically too unstable or have compromised the spinal canal. For instance, burst fractures often involve a breach of the posterior wall of the vertebral body, with bone fragments potentially retropulsed into the spinal canal. Injecting cement in this scenario significantly increases the risk of cement leakage into the canal, which could compress the spinal cord or nerve roots and cause new neurological deficits.
A fracture that has collapsed almost completely, sometimes called vertebra plana or having a height loss greater than 70 to 75%, may also rule out the procedure. In these cases, there is insufficient residual bone volume to safely insert the instruments or effectively restore height. Kyphoplasty is designed for vertebral body compression, not for the stabilization of pain that originates purely from degenerative disc disease or other non-fracture-related spine conditions.
Systemic Health Barriers
A patient’s general health is a major consideration, requiring risks to be weighed against the expected benefits. Individuals with severe cardiopulmonary disease, such as unstable angina or advanced chronic obstructive pulmonary disease (COPD), may not be able to safely tolerate the conscious sedation or general anesthesia required for the surgery. These conditions also increase the risk of a pulmonary cement or marrow embolism, which can be a serious complication of the procedure.
The overall prognosis of the patient must also be factored into the decision-making process. If a patient is suffering from an end-stage disease, such as advanced metastatic cancer unrelated to the fracture site, the expected quality-of-life benefit from the procedure may be minimal. In such situations, the risk of a complication and the stress of the operation may outweigh the limited potential for long-term improvement.
In cases of severe systemic bone diseases, the quality of the bone may be too poor to securely contain the cement. Conditions like advanced osteogenesis imperfecta or certain severe forms of osteopenia may mean that the pressure from inflating the balloon or injecting the cement risks causing an immediate fracture in an adjacent vertebra.