Kyphoplasty and Vertebroplasty for

Osteoporotic vertebral fractures are common and affect a large percentage of the elderly population. These fractures can lead to significant pain and deformity in the spine, particularly kyphosis, which can further impair a person’s quality of life. Traditional non-surgical treatments like pain medications and physical therapy have proven ineffective for many patients, which has led to the development of surgical procedures like vertebroplasty and kyphoplasty. These minimally invasive procedures provide significant relief by stabilizing the spine and correcting deformities caused by osteoporotic fractures.

How Common It Is and Who Gets It? (Epidemiology)

Osteoporotic vertebral fractures are widespread, with over 100 million people globally affected by osteoporosis and its complications. The prevalence of vertebral fractures increases with age, particularly in women after menopause due to a decline in bone density. The fractures often result in kyphosis, a condition that can impair lung function and lead to other complications, such as chronic pain and limited mobility.

Why It Happens – Causes (Etiology and Pathophysiology)

Osteoporotic vertebral fractures occur when the bones become weak and brittle, often due to conditions like osteoporosis. These fractures can happen after minor trauma, or even spontaneously in severe cases. As the vertebrae weaken, they may collapse, causing the characteristic forward curvature of the spine known as kyphosis. The compression of the spinal cord and nerve roots can lead to pain, numbness, weakness, and difficulty with movement.

How the Body Part Normally Works? (Relevant Anatomy)

The spine consists of 33 vertebrae, with the cervical, thoracic, and lumbar regions responsible for supporting the body’s weight and facilitating movement. Between each vertebra lies an intervertebral disc, which acts as a cushion and allows for flexibility. In the case of osteoporotic fractures, these discs collapse or become damaged, leading to spinal deformity and nerve compression. Vertebroplasty and kyphoplasty aim to restore stability to the spine and relieve pressure on the nerves.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with osteoporotic vertebral fractures often experience sudden back pain, which may be sharp or aching. Over time, the pain may become more chronic and can be accompanied by deformities such as a hunched or stooped posture (kyphosis). In severe cases, the compression of spinal nerves can lead to symptoms like numbness, tingling, or weakness in the arms and legs. Additionally, patients may experience difficulty with breathing or digestion due to the curvature of the spine.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis is typically based on the patient’s symptoms and physical examination, along with imaging studies like X-rays, CT scans, or MRIs. These imaging techniques help to identify the location and severity of the fractures, as well as the degree of spinal deformity. For kyphoplasty and vertebroplasty, fluoroscopic imaging is used during the procedure to guide the surgeon in real-time.

Classification

Osteoporotic vertebral fractures can be classified based on the severity of the fracture and the degree of kyphosis. The fractures are typically classified as mild, moderate, or severe based on the level of vertebral collapse and associated spinal deformity. Kyphosis is often measured in terms of the wedge angle or the degree of forward curvature in the spine. These classifications help determine the best course of treatment.

Other Problems That Can Feel Similar (Differential Diagnosis)

Several other conditions can present with symptoms similar to osteoporotic vertebral fractures, including herniated discs, degenerative disc disease, and spinal stenosis. It is important for the physician to differentiate between these conditions through imaging and clinical assessment to ensure the correct diagnosis and treatment.

Treatment Options

Non-Surgical Care: The first line of treatment often involves conservative measures such as pain management, physical therapy, and the use of braces to stabilize the spine. However, these methods often fail to provide long-term relief for patients with more severe fractures.

Non-Surgical Care – Non-Operative Treatment:
Physical therapy, medications, and spinal braces are commonly used to manage osteoporotic vertebral fractures. These treatments help to alleviate pain and improve spinal mobility but may not address the underlying structural issues.

Surgical Care:
Surgical options like vertebroplasty and kyphoplasty are recommended for patients with more severe pain or deformities that do not respond to non-surgical treatments. Both procedures are minimally invasive and involve the injection of cement into the vertebral body to stabilize the fracture and relieve pain.

Recovery and What to Expect After Treatment

After vertebroplasty or kyphoplasty, most patients experience significant pain relief, often within hours of the procedure. Patients may need to wear a neck or back brace for a period of time to support the spine as it heals. Physical therapy is often recommended to improve strength and flexibility. While recovery times vary, most patients can return to normal activities within a few weeks.

Possible Risks or Side Effects (Complications)

Although vertebroplasty and kyphoplasty are generally safe procedures, complications can occur. These may include infection, cement leakage, nerve injury, or increased risk of fractures in adjacent vertebrae. However, these complications are rare, especially when the procedure is performed by experienced surgeons.

Long-Term Outlook (Prognosis)

For most patients, kyphoplasty and vertebroplasty provide long-term relief from pain and improvement in quality of life. The procedures help restore vertebral height and correct spinal deformity, which can reduce the risk of future fractures. However, long-term follow-up is important to monitor the healing process and prevent additional fractures.

Out-of-Pocket Costs 

Medicare

CPT Code 22510 – Vertebroplasty: $401.05
CPT Code 22513 – Kyphoplasty: $1,249.27

Under Medicare, 80% of the approved amount for these procedures is covered once the annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—generally cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved vertebroplasty and kyphoplasty surgeries. These supplemental plans work directly with Medicare to provide comprehensive coverage for vertebral stabilization procedures.

If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it functions as a secondary payer once Medicare processes the claim. After your deductible is satisfied, the secondary plan can cover the remaining balance, including coinsurance or any uncovered charges. Most secondary insurance plans typically have a small deductible, ranging from $100 to $300, depending on the policy and provider network.

Workers’ Compensation
If your vertebral compression fracture requiring vertebroplasty or kyphoplasty resulted from a workplace injury, Workers’ Compensation will pay for all medical and surgical costs. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.

No-Fault Insurance
If your vertebral fracture or spinal condition requiring these procedures is a result of a motor vehicle accident, No-Fault Insurance will cover all related surgical and hospital expenses, including vertebroplasty and kyphoplasty. The only potential out-of-pocket expense would be a small deductible depending on your individual policy terms.

Example
Jack, a 70-year-old patient with an osteoporotic vertebral fracture, underwent kyphoplasty (CPT 22513) to relieve his pain and restore vertebral height. His estimated Medicare out-of-pocket cost was $1,249.27. Since Jack had supplemental insurance through AARP Medigap, the remaining 20% not covered by Medicare was fully paid, leaving him with no out-of-pocket expenses for his procedure.

Frequently Asked Questions (FAQ)

Q. What is the difference between vertebroplasty and kyphoplasty?
A. Kyphoplasty involves the additional step of balloon inflation to restore vertebral height before cement injection, whereas vertebroplasty only involves cement injection.

Q. Is kyphoplasty or vertebroplasty better for pain relief?
A. Both procedures provide significant pain relief, but kyphoplasty may offer better results in terms of correcting spinal deformities and restoring vertebral height.

Q. How long is the recovery after vertebroplasty or kyphoplasty?
A. Recovery time varies, but most patients experience pain relief within hours and can return to normal activities within a few weeks.

Summary and Takeaway

Vertebroplasty and kyphoplasty are effective, minimally invasive procedures for treating osteoporotic vertebral fractures. These procedures offer significant pain relief, restore spinal function, and improve quality of life for patients suffering from spinal deformities caused by osteoporosis.

Clinical Insight & Recent Findings

A recent study conducted a meta-analysis comparing the efficacy of vertebroplasty (VP) and kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (OVCF).

The study found that while both procedures effectively stabilize fractures and relieve pain, KP outperformed VP in terms of vertebral compression rate, Cobb angle, and the incidence of cement leakage. Specifically, KP demonstrated superior outcomes in restoring vertebral height and alignment, as well as reducing the risk of cement leakage, a common complication of VP.

However, no significant differences were observed in pain reduction or spinal function between the two techniques, suggesting that both remain viable options depending on patient-specific factors. (“Study of vertebroplasty vs kyphoplasty for osteoporotic fractures – See PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

The procedure is typically performed by an orthopedic surgeon or neurosurgeon specializing in spinal surgery. A multidisciplinary team, including radiologists and anesthesiologists, may also be involved.

When to See a Specialist?

You should see a spine specialist if you experience persistent neck or back pain, spinal deformity, or other symptoms such as numbness or weakness in the limbs.

When to Go to the Emergency Room?

Seek emergency care if you experience severe pain, sudden weakness, loss of bladder or bowel control, or difficulty breathing due to a spinal fracture.

What Recovery Really Looks Like?

Recovery after vertebroplasty or kyphoplasty typically involves a short hospital stay, pain management, and physical therapy. Most patients can return to normal activities within a few weeks.

What Happens If You Ignore It?

Ignoring spinal fractures or deformities can lead to increased pain, further deformity, and a higher risk of additional fractures. Surgical intervention is recommended to prevent these complications.

How to Prevent It?

Maintaining bone health through weight-bearing exercises, proper nutrition (calcium and vitamin D), and medication for osteoporosis can help reduce the risk of vertebral fractures.

Nutrition and Bone or Joint Health

A diet rich in calcium and vitamin D is essential for maintaining bone strength. Regular exercise, particularly weight-bearing activities, can help prevent osteoporosis and reduce the risk of fractures.

Activity and Lifestyle Modifications

Patients are encouraged to avoid heavy lifting, twisting, and bending during recovery. A spine-friendly lifestyle that includes ergonomic adjustments at work and home can also help prevent further spinal issues.

Do you have more questions?