Kyphoplasty: What to Expect on the Day of Surgery

Kyphoplasty (sometimes called “vertebral augmentation”) is a minimally-invasive surgery that treats back pain associated with spine compression fracture due to the progression of osteoporosis or injury. It uses a surgical balloon to create space in the affected vertebrae and guide the injection of fast-hardening bone cement that repairs and reinforces the area.

Though kyphoplasty is not an open surgery—it relies on imaging to guide injection of the balloon and cement—it’s still a significant procedure that requires preparation on the part of medical team and patient alike.

As with any such procedure, if you’re considering this option or are planning on undergoing it, it’s important to understand a little about how it works, and what happens on the day of surgery.

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Before the Surgery

Before any surgery can begin, doctors will need to ensure that your body is ready for the treatment and that the chances of complications are reduced. As such, when you come in for your kyphoplasty appointment, you’ll need to undergo an initial evaluation as well as some testing.

What can you expect during this pre-operation assessment? Here’s a quick breakdown:

  • Initial examination: Before the surgery begins or any medications administered, medical staff will need to assess vital signs, such as heart rate and blood pressure. In addition, they’ll ask you about how your back is feeling as well as any medications (both prescribed and over-the-counter) or supplements you’re taking. 
  • Imaging: In some cases, doctors may want to perform a final X-ray or magnetic resonance imaging (MRI) scan to assess the damaged vertebrae one last time before work begins in earnest.
  • Blood tests: Assessments of blood may also be necessary prior to this operation. The doctor or another member of medical staff will need to draw a sample from you.
  • Consultation with the anesthesiologist: Since kyphoplasty can be performed either under general anesthesia (in which you are asleep), or localized anesthesia with an intravenous (IV) drip, you’ll have to meet with the anesthesiologist. They’ll discuss the options and assess you to determine safe and effective dosage to ensure comfort during the procedure.
  • Pre-operative drugs: Along with anesthetic drugs, antibiotics will be administered about 30 minutes prior to the procedure to lower the risk of infection. In addition, doctors may give you a drug called Midazolam hydrochloride syrup, which helps ease anxiety and further relaxes you.

Following assessment, consultation with the anesthesiologist, and administration of anesthetic and other drugs, you’ll be taken to the operating room, and asked to lie on your stomach.

During the Surgery

Since kyphoplasty is not an open procedure, it only takes about one hour, though it can go longer if multiple vertebrae that are damaged. It’s typically performed by specialists that are either “interventional radiologists” or “neuroradiologists.” How does this surgery work? What happens during the procedure? Here’s a quick rundown:

  • Positioning and preparation: Once you’re in the operating room, you’ll be asked to lay face down on the operating table, and be hooked to the IV that delivers anesthesia and other pre-operative drugs. The site through which the doctor will access the damaged area will be shaved, cleaned, and made sterile, and then covered with a surgical drape.
  • Incision: Kyphoplasty relies on the use of a special syringe called a “trocar.” The doctors will need to make a very small incision in your back near the problem area. The small size of this opening means quicker recovery time and less risk of complications.
  • Guidance: Using X-ray fluoroscopy—an imaging technique that employs a radioactive dye to improve contrast—or other video imaging techniques, the surgeon will then guide the trocar into place. Typically, it’s guided through the back muscles and positioned right at the damaged vertebra or vertebrae.
  • Placing the balloon tamponade: Crucial to the kyphoplasty procedure is the use of a specialized balloon—called a balloon tamponade (“balloon tamp” for short)—in the affected area. Using the trocar, the doctor puts this balloon into the damaged vertebra, and it’s then inflated to create a space. It’s then removed.
  • Application of bone cement: After the balloon is taken out, the doctor will then use the trocar to deliver bone cement to the affected joint. This material—which has the appearance of toothpaste—hardens quickly.
  • Final imaging and pressure: Since the size of the incision is so small, you won’t need to be stitched up; instead, doctors bandage and apply pressure to it. In many cases, doctors may perform additional imaging after the surgery to ensure that everything is in place. Once everything is complete, the doctors will unhook you from the IV.

After the Surgery

Unlike more extensive surgeries, discharge is relatively quick after kyphoplasty, and, as mentioned, most are able to go home the same day. What does this initial, in-hospital recovery period look like? There are several steps:

  • In the operating room: Before you’re taken into the recovery room, you’ll have to rest in the operating room for about five to 10 minutes to ensure that the bone cement has completely hardened.
  • Recovery room: Once doctors are sure that the cement has stiffened, you’ll be taken to a recovery room. There, doctors will need to carefully monitor you, tracking important vital signs such as heart rate and blood pressure, while also looking out for any other potential complications.
  • Discharge: Once it’s clear that there are no immediate issues, you’ll have a final consultation with the medical staff. They’ll go over the medications you need to take, discuss physical therapy (necessary after these procedures), and other important information.

You cannot drive after kyphoplasty, so make sure you have arranged for transportation.

Because of the sedation, you cannot drive after kyphoplasty. Make sure you have arranged for transportation.

A Word From Verywell

The treatment of back or spine problems is often an ongoing, extended process; even though most patients feel relief from pain within a couple days of kyphoplasty, they’ll have to continue to do work to prevent discomfort from returning.

And while the prospect of this type of surgery can be intimidating, it’s important to remember just how minimally-invasive and safe it is. Despite some risks, overall prognosis is very good with this procedure, and it’s proved invaluable for countless patients.

There’s much to weigh when it comes to back pain, so if you’re considering this treatment or will be undergoing it, be sure to learn as much as you can about it. Armed with good information—and alongside a dedicated medical staff—kyphoplasty very well may be the key to brighter, pain-free days ahead. 

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Article Sources
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  4. American Academy of Neurological Surgeons. Vertebral compression fractures: symptoms, complications, diagnosis and treatments. 2020. 

  5. Brown C, Wong D. Kyphoplasty for an osteoporosis fracture. 2009.