Balloon kyphoplasty for spinal fractures: when it is used and what NICE says

NICE describes percutaneous balloon kyphoplasty, without stenting, as one of two procedures, with percutaneous vertebroplasty, that can be used for osteoporotic vertebral compression fractures. Percutaneous means through the skin, rather than through an open operation.

Kyphoplasty and vertebroplasty are related techniques, and NICE’s guidance concerns both together. Your surgical team can explain exactly how the version they would use works and what it involves for you.

NICE explains that vertebral compression fractures usually occur when the front of the vertebral body collapses and may be caused by trauma, cancer or osteoporosis. Osteoporotic compression fractures can cause the spine to curve and lose height, and can result in pain, difficulties in breathing, gastrointestinal problems, sleep disturbances and difficulties performing activities of daily living. High doses of analgesics used to treat such pain can have significant adverse effects.

The NHS describes osteoporosis as a condition that weakens bones, making them fragile and more likely to break, which often develops slowly and is only diagnosed when a fall or sudden impact causes a fracture. It says broken spinal bones are a common cause of long-term pain, and that in some older people repeated spinal fractures cause a stooped posture.

NICE adds that the prevalence of vertebral fractures increases with age and is more common in women, that not all fractures come to the attention of clinicians and are not always recognised on X-rays, and that clinically evident osteoporotic vertebral compression fractures are associated with increased mortality.

NICE technology appraisal guidance 279, published in April 2013 and reviewed in January 2016 with no change to recommendations, states that percutaneous vertebroplasty, and percutaneous balloon kyphoplasty without stenting, are recommended as options for treating osteoporotic vertebral compression fractures only in people who have severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management, and in whom the pain has been confirmed to be at the level of the fracture by physical examination and imaging.

The accompanying text explains that treating vertebral compression fractures aims to restore mobility, reduce pain and minimise new fractures, and that non-invasive treatment such as pain medication, bed rest and back braces focuses on alleviating symptoms and supporting the spine. NICE’s interventional procedures guidance says that these procedures should be done only after discussion with a specialist multidisciplinary team and in a facility with access to spinal surgery, and for vertebroplasty that it should be limited to people whose pain does not respond to more conservative treatment.

A procedure on one vertebra does not treat the bone weakness that caused the fracture. The NHS says osteoporosis can be treated with bone-strengthening medicines, and that treatment is based on treating and preventing broken bones and taking medicine to strengthen the bones, with the decision depending on your risk of breaking a bone in future. The risk is estimated with tools such as FRAX or Q-Fracture and a bone density (DEXA) scan.

The NHS suggests regular exercise, healthy eating with foods rich in calcium and vitamin D, a daily supplement of 10 micrograms of vitamin D, giving up smoking and reducing alcohol. It also advises reducing the chance of falls by removing hazards at home and having regular sight and hearing tests, and using painkillers, hot and cold treatments and relaxation techniques to help recovery from a fracture.

Reasonable questions include whether your pain has been confirmed as coming from the fractured vertebra, whether pain management has been optimised, what the procedure would involve and what the risks are, whether you would be treated at a centre with spinal surgery on site, and what treatment for the underlying osteoporosis is planned alongside.

The NHS advises speaking to a GP or nurse if you are worried about living with a long-term condition, and notes that the Royal Osteoporosis Society is the UK national charity for the condition.