Kyphoplasty for Compression Fractures | Amit Sharma, MD

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This animation demonstrates the OmniCurve^® curved-balloon kyphoplasty workflow used by Dr. Sharma. The exact approach may vary according to the fracture pattern and the patient’s anatomy. Video used with permission from Stryker.

Written by Amit Sharma, MD

Interventional spine and pain physician, founder of SpinePain Solutions, and fellowship-trained at Johns Hopkins. Dr. Sharma has performed kyphoplasty and vertebral augmentation procedures for 22 years.

Kyphoplasty is a minimally invasive vertebral augmentation procedure used to stabilize selected painful vertebral compression fractures. A balloon is placed inside the fractured vertebral body, inflated to create a cavity and sometimes reduce part of the collapse, and then removed. Polymethylmethacrylate, or PMMA, bone cement is placed into the treated area to stabilize the broken bone.

Kyphoplasty may be considered for fractures caused by osteoporosis, selected traumatic injuries, or cancer involving a vertebra. Those groups are not interchangeable. Each requires a different evaluation of fracture activity, mechanical stability, posterior-wall integrity, neural compression and the need for additional treatment.

Quick Answer

Osteoporosis: The most common clinical setting; kyphoplasty may fit an active painful fracture that limits mobility and has not improved adequately with appropriate nonsurgical care.
Trauma: May fit selected stable compression or carefully evaluated incomplete burst patterns, but not an unstable injury or fracture causing important neural compression.
Cancer or myeloma: May stabilize a painful pathological fracture, but it does not treat the tumor and must be coordinated with the oncologic plan.
Across all causes: The fracture must be clinically relevant and anatomically suitable for controlled cement augmentation.

What Is Kyphoplasty and What Does It Treat?

A vertebral compression fracture occurs when a spinal bone partially collapses. The fracture can cause focal mid-back or lower-back pain that worsens with standing, walking, coughing, rolling in bed or changing position. Severe pain can reduce walking, sleep and independence, particularly in older adults.

Kyphoplasty treats the fractured vertebral body. It does not directly decompress the spinal canal, fuse adjacent vertebrae or correct every fixed deformity. Its principal objective is to stabilize painful fracture motion from within the vertebra. Partial restoration of vertebral height may occur when the fracture remains mobile, but height restoration is variable and is not the sole measure of success.

An imaging abnormality alone is not enough. Many patients have old compression deformities that are no longer painful. History, focal examination findings and imaging must identify the same active fracture.

A compressed vertebra is not automatically an indication for kyphoplasty.

The important question is whether the fracture remains active and is responsible for the current pain and loss of function. MRI is often helpful because marrow edema can support that determination.

Is Kyphoplasty Appropriate for Osteoporotic, Traumatic and Cancer-Related Fractures?

Kyphoplasty may have a role in all three categories, but candidacy differs substantially. Cause, morphology and stability must be assessed together.

Fracture Cause	When Kyphoplasty May Fit	When Another or Additional Pathway Is Needed
Osteoporosis	Active painful compression fracture corresponding with the examination and imaging; persistent pain or mobility loss despite appropriate nonsurgical care	Healed or asymptomatic deformity, rapidly improving symptoms, pain from another structure, major instability or neural compression
Trauma	Selected stable compression fractures or carefully assessed Type A patterns without an urgent neurological or instability indication	Posterior-ligament injury, translation, progressive deformity, substantial retropulsion, unstable burst fracture or neurological deficit
Cancer or myeloma	Painful pathological compression fracture with a mechanical pain component that can be safely stabilized with cement	Epidural tumor, spinal-cord compression, extensive cortical destruction, infection or instability requiring decompression, fixation or reconstruction; oncologic treatment remains necessary

Osteoporotic Compression Fractures

This is the most established everyday application. A typical candidate has new focal pain, reduced mobility and an acute or subacute fracture that remains active on MRI. A minor fall, lifting event or even ordinary movement may trigger a fracture when the bone is severely weakened.

Kyphoplasty is not required for every osteoporotic fracture. Analgesic treatment, bracing when appropriate and gradual mobilization may be reasonable when pain is manageable and function is improving. Procedural consideration becomes more relevant when pain remains severe, mobility is deteriorating or conservative treatment is not providing adequate progress.

Traumatic Compression and Burst Fractures

The word traumatic covers a wide range of injuries. A stable wedge compression fracture is very different from a fracture with posterior-ligament disruption, vertebral translation or bone pushed into the spinal canal. Kyphoplasty may be used alone in selected stable patterns or combined with posterior instrumentation in selected cases, but it cannot substitute for fixation when the spine is mechanically unstable.

CT is often important for defining cortical disruption and canal involvement. MRI can assess neural structures, ligaments and fracture activity. Progressive deformity, significant retropulsion or neurological loss requires spine-trauma evaluation rather than cement augmentation alone.

Cancer-Related and Myeloma Fractures

Metastatic disease and multiple myeloma can weaken a vertebra and create painful mechanical instability. Kyphoplasty may reduce fracture-related pain and improve function in selected patients, but it does not remove or cure the cancer.

Evaluation should address:

Whether the pain is mechanical, tumor-related, neurological or mixed
Whether epidural disease or spinal-cord compression is present
The degree of posterior-wall and cortical destruction
Whether tissue diagnosis or biopsy is needed
Whether tumor ablation should accompany augmentation
The roles and timing of radiation, systemic therapy or surgery
Whether the vertebra requires fixation beyond cement augmentation

The CAFE randomized trial found faster functional improvement with balloon kyphoplasty than nonsurgical management in a selected group of patients with cancer-related vertebral compression fractures. Those results should not be generalized to patients with spinal-cord compression, extensive epidural tumor or gross instability.

Who May Be a Candidate for Kyphoplasty?

The strongest candidate generally has a painful active fracture that limits essential function and can be treated safely through vertebral augmentation.

Findings Supporting Consideration	Findings Requiring Another Pathway or More Evaluation
Focal pain corresponding with a recent vertebral compression fracture	Incidental old compression deformity without matching symptoms
MRI marrow edema or another accepted sign of an active fracture	Pain primarily from a disc, facet joint, muscle, sacroiliac joint or another vertebra
Pain limiting walking, standing, sleep, breathing mechanics or daily care	Progressive weakness, spinal-cord compression or another neurological emergency
Inadequate improvement with an appropriate individualized trial of conservative care	Symptoms already improving sufficiently with nonsurgical treatment
Anatomy permitting controlled access and cement placement	Major posterior-wall destruction, severe canal compromise or mechanical instability
Acceptable infection, bleeding, anesthesia and cardiopulmonary risk	Active infection, uncorrected coagulopathy or uncontrolled medical illness

Why MRI Often Matters

An X-ray can show vertebral height loss but may not establish when the fracture occurred. MRI can identify marrow edema, evaluate neural structures and help distinguish an active fracture from an old healed deformity. CT may be more useful for detailed cortical anatomy, posterior-wall disruption and traumatic fracture morphology. Imaging selection depends on the clinical situation.

When Kyphoplasty Is Not Enough

Kyphoplasty does not directly remove retropulsed bone or epidural tumor from the spinal canal. It also does not provide the same stability as instrumented spinal fixation. Neurological compression, major instability, severe deformity, infection or another pain generator may require a different or combined treatment plan.

How Kyphoplasty Is Performed

Kyphoplasty is performed under fluoroscopic imaging. The anesthesia, access route and number of treated vertebrae depend on the patient’s medical condition, fracture anatomy and clinical setting.

Preparation, Positioning and Imaging

Symptoms, examination and imaging are reviewed before treatment. Medications, allergies, infection risk, coagulation status and cardiopulmonary conditions are assessed. The patient is generally positioned face down and receives local anesthesia with monitored sedation or general anesthesia according to the individualized plan. Fluoroscopy is used to confirm the vertebral level and guide each instrument.

The OmniCurve Curved-Balloon Workflow

The sequence below demonstrates the OmniCurve^® curved-balloon system and the unipedicular workflow Dr. Sharma uses in appropriate cases. Other kyphoplasty systems and access routes may use different instruments or somewhat different steps.

1. Insert the Curved Introducer

OmniCurve curved introducer and radiopaque sheath entering the vertebral body during kyphoplasty

The introducer and radiopaque sheath are advanced through the pedicle and directed across the vertebral body under fluoroscopic guidance.

2. Leave the Sheath in Position

Radiopaque sheath remaining inside the vertebral body after removal of the OmniCurve introducer

The introducer is removed while the curved sheath remains in the planned position inside the fractured vertebra.

3. Position the Balloon

$Kyphoplasty balloon advanced through the curved sheath into the fractured vertebral body$

The balloon catheter is advanced through the sheath to the intended treatment area.

4. Expose the Balloon

OmniCurve kyphoplasty balloon exposed by retracting the sheath inside the vertebral body

The sheath is retracted to expose the balloon within the vertebral body.

5. Inflate the Balloon

$Balloon inflation creating a controlled cavity inside a vertebral compression fracture$

The balloon is inflated under imaging guidance to create a cavity and, when the fracture remains reducible, may partially restore vertebral height.

6. Deflate and Remove the Balloon

Deflated kyphoplasty balloon removed before controlled bone cement placement

The balloon is deflated and removed. The sheath is repositioned to preserve access to the created cavity.

7. Place the Bone Cement

Controlled PMMA bone cement placement through a curved delivery system during kyphoplasty

PMMA bone cement is delivered under continuous fluoroscopic observation. The goal is safe fracture stabilization with appropriate cement distribution, not maximum filling.

Procedure illustrations used with permission from Stryker. OmniCurve^® is a registered trademark of Stryker. Illustrations are educational and do not represent every possible kyphoplasty technique.

What Cement Placement Looks Like Under Fluoroscopy

AP and lateral fluoroscopic views help assess instrument position and cement distribution in real time. These are representative examples from Dr. Sharma’s clinical practice. Individual fracture anatomy, cement volume and cement distribution vary.

AP fluoroscopic view after kyphoplasty showing PMMA cement distribution within the treated vertebral body — **AP view:** Front-to-back fluoroscopic image showing cement distribution within the treated vertebral body.

Lateral fluoroscopic view after kyphoplasty showing PMMA cement within the treated vertebral body — **Lateral view:** Side-view fluoroscopic image showing cement within the treated vertebral body.

Recovery Monitoring

After the instruments are removed, the access site is covered with a small dressing. The patient is observed while the cement completes its initial hardening and the effects of sedation or anesthesia diminish. Walking often begins during recovery when medically safe, and same-day discharge is common after an uncomplicated procedure.

Kyphoplasty Versus Other Vertebral Augmentation Options

These procedures share a stabilization objective but use different access, cavity-creation and cement-delivery methods. No device is automatically best for every fracture.

Approach	Practical Distinction	What Remains
Balloon kyphoplasty	A temporary balloon creates a cavity and may partially reduce a mobile fracture before cement placement	PMMA cement
Vertebroplasty	Cement is placed directly into the fracture without a balloon-cavity step	PMMA cement
SpineJack	Expandable titanium implants attempt controlled internal fracture reduction and remain in place during cement stabilization	Titanium implant plus PMMA cement
RF-TVA	Radiofrequency-activated cement preparation and targeted delivery are used to control the augmentation construct	PMMA cement

Balloon kyphoplasty often shows less radiographic cement leakage than vertebroplasty in comparative studies, but most detected leaks are asymptomatic and serious leakage complications can occur with either procedure. It is too strong to claim that the balloon step makes kyphoplasty categorically safer.

Timing, Cement Amount and Rapid Pain Relief

These questions deserve concise answers on the parent page and deeper treatment in their dedicated child articles.

Does Timing Matter?

Timing is individualized. A recent meta-analysis associated kyphoplasty performed within four weeks with better average pain outcomes than later treatment, but the included studies were heterogeneous and did not establish a universal deadline. Immediate treatment is not necessary for every fracture, and prolonged mandatory waiting is not appropriate when pain is severe, mobility is deteriorating and imaging confirms an active treatable fracture.

Is More Cement Better?

No. The goal is not to fill the vertebra with the maximum possible volume. The goal is adequate stabilization with safe, controlled distribution through the clinically important fracture region. Vertebral size, cement viscosity, fracture morphology, cortical defects and distribution matter more than a universal volume target.

Detailed guide: Read How Much Cement Is Enough in Kyphoplasty? for the full discussion of volume, viscosity and distribution.

Why Can Pain Improve Quickly?

Some patients improve within the first day or two, while others recover gradually. The most accepted explanation is stabilization of painful fracture micromotion. Reduced mechanical irritation and changes in fracture-site signaling may also contribute. Thermal or basivertebral-nerve mechanisms remain plausible but incompletely established explanations rather than proven primary mechanisms.

Detailed guide: Read Why Kyphoplasty Can Relieve Fracture Pain Quickly for a fuller discussion of the proposed mechanisms.

Recovery After Kyphoplasty

Same-day discharge is common after uncomplicated treatment, but it is not guaranteed. Recovery depends on the fracture cause, number of levels, baseline mobility, anesthesia and overall medical condition.

Walking commonly begins after observation and medical clearance.
Access-site soreness may continue for several days.
Fracture pain may improve rapidly or gradually over days to weeks.
A responsible adult should drive the patient home after sedation or anesthesia.
Driving should wait until sedating medication has been stopped and movement, attention and vehicle control are safe.
Lifting, bending and exercise restrictions are individualized.
Traumatic and cancer-related fractures may require additional restrictions or coordinated treatment.
Rehabilitation may later address gait, posture, strength, balance and fall prevention.

Numbness and weakness are not typical fracture-pain symptoms to dismiss. New or worsening neurological findings require prompt reassessment.

What Does the Evidence Show?

Evidence quality and treatment context differ by fracture cause.

Osteoporotic Fractures

The FREE randomized trial found faster improvement in pain, function, mobility and quality of life with balloon kyphoplasty than nonsurgical care in selected patients with acute painful fractures. A 2025 systematic review and meta-analysis reported moderate-certainty evidence of better average pain relief from one through 12 months and early disability improvement, but disability differences were not significant at six or 12 months. It found no significant difference in new vertebral-fracture risk.

These are group-level results. They do not establish that every active fracture requires a procedure or that every patient will improve.

Traumatic Fractures

A 2024 systematic review reported encouraging clinical and radiographic results for kyphoplasty and expandable implants in selected traumatic thoracolumbar fractures. Most available evidence was nonrandomized, and augmentation was sometimes combined with posterior fixation. It therefore supports careful selection rather than routine cement augmentation for every traumatic fracture.

Cancer-Related Fractures

The CAFE randomized trial found improved function at one month with kyphoplasty compared with nonsurgical management in selected patients with cancer and painful vertebral compression fractures. The trial allowed control-group crossover after one month and was industry funded. Kyphoplasty should be viewed as one component of a multidisciplinary cancer-fracture plan.

Mobility and Survival

Vertebral compression fractures are associated with frailty, immobility and increased mortality in older adults. Observational database studies have reported survival associations favoring vertebral augmentation, but treatment selection, baseline health and mobility create important confounding. Kyphoplasty may help an appropriately selected patient regain mobility; it should not be marketed as a procedure proven to extend life or prevent death.

Evidence review: Read Compression Fractures, Mobility and Life Expectancy for a closer look at the observational survival data and its limitations.

Risks and Limitations of Kyphoplasty

Kyphoplasty is minimally invasive, but it remains a spinal cement-augmentation procedure. Potential risks include:

Cement leakage into veins, discs, soft tissues or the spinal canal
Pulmonary cement embolism or another embolic complication
Bleeding, hematoma or infection
Nerve-root or spinal-cord injury
Pedicle, cortical, vascular or other access-related injury
Allergic reaction to cement, contrast or medication
Anesthesia- or sedation-related complications
Persistent pain or failure to improve
A new or adjacent vertebral fracture
Need for another augmentation procedure or a broader operation

Kyphoplasty also has important limitations. It does not treat osteoporosis or cancer, directly decompress the spinal canal, reliably correct an old fixed deformity, guarantee height restoration or prevent future fractures. It may not relieve pain arising from another structure.

What If Pain Continues or Gets Worse?

Mild access-site soreness can occur and should generally improve. Persistent, severe, escalating or newly different pain should be evaluated rather than automatically labeled normal recovery. Possible causes include residual fracture pain, a new vertebral fracture, facet or sacroiliac pain, infection, bleeding, neural compression or symptomatic cement leakage.

Cement seen outside the vertebral body on imaging is often asymptomatic. Its location and corresponding neurological or cardiopulmonary symptoms determine clinical importance.

Learn how postoperative pain is evaluated.

Read Pain After Kyphoplasty: What Is Normal, Possible Causes, Cement Leakage and Warning Signs for the full evaluation pathway.

Seek urgent evaluation for new or worsening weakness, loss of bowel or bladder control, saddle-region numbness, fever, wound drainage, chest pain, shortness of breath, fainting or rapidly escalating pain.

Does Kyphoplasty Treat Osteoporosis?

No. Kyphoplasty stabilizes the treated fracture but does not reverse the underlying loss of bone strength. A vertebral fragility fracture is an important warning that the patient remains at risk for another fracture.

A bone-health plan may include:

DEXA testing when appropriate
Vitamin D, calcium and secondary-cause laboratory evaluation
Nutrition review
Osteoporosis medication selected for the patient’s fracture risk and medical history
Weight-bearing and resistance exercise when safe
Balance training and fall-risk reduction
Review of medications and conditions that increase fall or fracture risk

Alternatives and Additional Treatments

Depending on the fracture and the patient, options may include:

Analgesic treatment, activity modification and gradual mobilization
Bracing when appropriate
Osteoporosis treatment and fall prevention
Vertebroplasty
SpineJack
Radiofrequency-targeted vertebral augmentation
Biopsy or tumor ablation with augmentation when clinically appropriate
Radiation or systemic cancer therapy
Surgical fixation, decompression or reconstruction for instability, deformity or neural compression

Does Your Compression Fracture Fit Kyphoplasty?

A focused evaluation can determine whether the fracture remains active and whether kyphoplasty, another augmentation approach, continued nonsurgical care or surgical evaluation is most appropriate.

Request an Evaluation

Frequently Asked Questions

What is kyphoplasty?

Kyphoplasty is a minimally invasive vertebral augmentation procedure used to stabilize selected painful vertebral compression fractures. A balloon is inflated inside the fractured vertebral body to create a cavity and may reduce part of the collapse. The balloon is removed before PMMA bone cement is placed.

Is kyphoplasty appropriate for osteoporotic, traumatic and cancer-related fractures?

Kyphoplasty may be considered for selected painful fractures in all three categories, but candidacy differs. Osteoporotic fractures are the most common application. Traumatic fractures require formal stability and neurological assessment, while cancer-related fractures require coordination with oncologic treatment. Kyphoplasty alone is generally insufficient when there is spinal-cord compression, major instability or another indication for decompression or fixation.

Who may be a candidate for kyphoplasty?

A candidate generally has focal pain and functional limitation caused by an active vertebral compression fracture that corresponds with the examination and imaging. The fracture must be anatomically suitable for controlled cement augmentation, and appropriate nonsurgical care should have provided inadequate improvement unless the clinical situation warrants earlier treatment.

Why is MRI often important before kyphoplasty?

MRI can identify marrow edema that supports an active fracture, evaluate neural structures and help distinguish a recent painful fracture from an old healed deformity. CT may add better detail about cortical disruption, posterior-wall anatomy and traumatic fracture morphology.

How is kyphoplasty different from vertebroplasty?

Both procedures stabilize a fractured vertebra with PMMA cement. Kyphoplasty uses a temporary balloon to create a cavity before cement placement, while vertebroplasty places cement directly into the fractured vertebra without a balloon step. Neither approach is automatically best for every fracture.

How is kyphoplasty different from SpineJack?

Kyphoplasty removes the balloon before cement is placed. SpineJack leaves an expanded titanium implant within the vertebral body and places PMMA cement around it. The choice depends on fracture activity, reducibility, morphology, pedicle anatomy and the intended mechanical result.

Is more cement better during kyphoplasty?

Not necessarily. The goal is adequate stabilization with controlled cement distribution, not the maximum possible volume. Vertebral size, fracture morphology, cement viscosity, cortical defects and leakage risk affect the amount and pattern of cement placement.

Does timing matter for kyphoplasty?

Timing can matter, but there is no universal deadline. Earlier treatment may fit a patient with severe persistent pain, loss of mobility and an active fracture on imaging, while continued conservative care may fit someone who is improving. Fracture cause, anatomy and medical risk also influence timing.

How long is recovery after kyphoplasty?

Same-day discharge and early walking are common after an uncomplicated procedure, but recovery varies. Access-site soreness may last several days, and fracture pain may improve rapidly or gradually. Activity restrictions depend on the fracture, treated levels, baseline mobility and overall health.

What are the risks of kyphoplasty?

Risks include cement leakage, embolic complications, bleeding, infection, neural or access-related injury, allergic or anesthesia reaction, persistent pain, another vertebral fracture and the need for another procedure. Serious complications are uncommon but possible.

What if pain continues after kyphoplasty?

Persistent pain may come from the treated fracture, a new fracture, a facet or sacroiliac joint, muscle, infection, bleeding, neurological compression or symptomatic cement leakage. Severe, worsening or newly different pain should be reassessed rather than assumed to be routine recovery.

Does kyphoplasty treat osteoporosis or cancer?

No. Kyphoplasty stabilizes the treated vertebral fracture. Osteoporosis requires a separate bone-health and fracture-prevention plan, while cancer requires coordinated oncologic treatment.

References

American College of Radiology. ACR Appropriateness Criteria: Management of Vertebral Compression Fractures, 2022 update. Read source →
Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with nonsurgical care for vertebral compression fracture: a randomized controlled trial. Lancet. 2009. Read source →
Encalada S, et al. The effectiveness of balloon kyphoplasty compared with conservative treatment for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Interventional Pain Medicine. 2025. Read source →
Moura DL, et al. The role of kyphoplasty and expandable intravertebral implants in the treatment of traumatic vertebral compression fractures: a systematic review. 2024. Read source →
Berenson J, et al. Balloon kyphoplasty versus nonsurgical fracture management for painful vertebral body compression fractures in patients with cancer: the CAFE randomized trial. Lancet Oncology. 2011. Read source →
Khan MA, et al. The effect of time to balloon kyphoplasty on osteoporotic vertebral compression fractures: a systematic review with meta-analysis. North American Spine Society Journal. 2024. Read source →
Rose LD, Bateman G, Ahmed A. Clinical significance of cement leakage in kyphoplasty and vertebroplasty: a systematic review. European Spine Journal. 2024. Read source →
Noriega D, et al. Randomized comparison of implantable titanium vertebral augmentation with balloon kyphoplasty in osteoporotic vertebral compression fractures: the SAKOS study. Spine Journal. 2019. Read source →
Stryker. OmniCurve curved balloon system: procedure workflow and product information. Read source →

Medical disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Procedure selection depends on symptoms, examination, imaging, fracture age and cause, neurological status, bone quality, stability, medical history and physician judgment. New or progressive weakness, bowel or bladder dysfunction, saddle-region numbness, chest pain or difficulty breathing requires urgent medical evaluation.