Kyphoplasty & Vertebroplasty —
profound pain relief from a spinal fracture

Most vertebral compression fractures will eventually stabilise with conservative management over 6–12 weeks. Kyphoplasty is an elective procedure — it is not required in every case, and many patients with mild-to-moderate fracture pain can be managed successfully with rest, pain medication, and a back brace. The indications for kyphoplasty are: severe pain that is limiting daily function and not responding adequately to conservative management after a reasonable trial; pain severe enough that the patient cannot mobilise, is losing independence, or has become wheelchair-dependent purely from pain; and in some cases, progressive vertebral collapse with significant deformity that is affecting quality of life or alignment. The consultation establishes which category applies to you. For patients with severe, debilitating pain, the question is often not whether kyphoplasty is appropriate — it is why it hasn’t been done sooner.

Both procedures stabilise the fracture by injecting bone cement into the fractured vertebral body under fluoroscopic guidance. The key technical difference is that kyphoplasty first inflates a balloon inside the vertebra to create a cavity and partially restore vertebral height before cement is injected — the cement goes into the pre-formed cavity at low pressure, which reduces leakage risk. Vertebroplasty injects cement directly without the balloon step — it is faster and less expensive, but injects cement at higher pressure without a pre-formed cavity. Based on articles retrieved from PubMed, clinical studies have found that pain relief outcomes are similar between the two procedures; kyphoplasty produces more height restoration. The SpineJack produces the greatest height and alignment restoration of the three and is offered for more severe fractures.

The Stryker SpineJack® is an FDA-approved titanium implant system that uses two small expandable devices — one on each side of the vertebral body — to mechanically restore vertebral height before bone cement is injected. Unlike the balloon in standard kyphoplasty, which creates a cavity by compressing the cancellous bone, the SpineJack expands by an unfolding mechanism that more directly lifts the collapsed vertebral endplates. Based on articles retrieved from PubMed, a multi-institutional study published in AJNR found SpineJack produced significantly better worst-pain scores and superior height and alignment restoration compared to both kyphoplasty and vertebroplasty. It is offered here for patients with moderate-to-severe vertebral collapse where meaningful height and deformity correction is a treatment goal — particularly for fractures with more than 50% height loss, progressive kyphotic deformity, or significant wedge collapse.

Pain relief after kyphoplasty is often immediate and dramatic. Many patients notice significant improvement within hours of the procedure, as the cement cures and stabilises the fractured vertebra. This is one of the most striking aspects of kyphoplasty — the rapidity and magnitude of relief relative to the minimally invasive nature of the procedure. Patients who were unable to stand from pain without assistance can frequently walk out of the surgery center the same day. Not every patient has a complete response — some have residual pain from muscle spasm, adjacent fractures, or other sources — but the improvement in fracture pain specifically is typically profound. Based on a systematic review of 930 patients published in Pain Physician, most patients with symptomatic fractures achieved rapid and effective pain relief after percutaneous kyphoplasty.

Almost certainly yes, if you have not already been evaluated. A vertebral compression fracture is the most common clinical presentation of osteoporosis — it means your bone density has crossed the fracture threshold. Having one compression fracture significantly increases your risk of additional fractures. Dr. Katsevman orders a DEXA scan if one has not been recently performed, evaluates for secondary causes of bone loss with laboratory testing, and refers to endocrinology or your primary care physician for pharmacological treatment when indicated. Pharmacological osteoporosis treatment — bisphosphonates, denosumab, or anabolic agents — reduces the risk of future fractures significantly. Treating the fracture without treating the osteoporosis is an incomplete plan.

Yes — kyphoplasty and vertebroplasty are covered by Medicare and most major commercial insurers for acute, painful vertebral compression fractures in patients who have failed conservative management and meet imaging criteria for an acute fracture. Prior authorisation is typically required. The practice manages insurance coordination for all patients. SpineJack coverage varies by insurer — it has FDA approval and is covered by Medicare and many commercial plans, with prior authorisation required. Specific coverage requirements are reviewed at the time of consultation and prior authorisation.