Kyphoplasty is a procedure that treats compression fractures in the spine. It relieves pain at the site, but some people may experience pain even after the procedure. Treating it includes taking medications and doing physical therapy.

Doctors may recommend kyphoplasty as part of their treatment for osteoporotic or bone compression fractures.

Vertebroplasty involves injecting a special type of cement to strengthen the bone. Kyphoplasty involves inserting a balloon inside the bone using a long thin needle to make space for the cement.

This article explains why a person may continue to have back pain after kyphoplasty and what they can do to relieve it.

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Kyphoplasty helps relieve pain caused by a compression fracture. Pain at the site where the surgeon inserted the needle is standard and should go away within a few weeks. However, some people experience continued back pain following the procedure.

Research from 2020 explored the incidence of and risk factors for back pain remaining after percutaneous, or under the skin, kyphoplasty. The study population received the kyphoplasty treatment for osteoporotic vertebral compression fractures.

The findings revealed that 7.8% of the 809 people included in the study still had back pain after the kyphoplasty. Independent risk factors for the continued pain included:

  • having a cavity inside a fractured vertebra
  • swelling due to fluid being trapped behind the membrane covering the back muscles
  • injury to the joints connecting the vertebrae
  • having bone cement distributed separately on each side of the vertebra

Treatment approaches for vertebral compression fractures include conservative medical management, which may involve:

Spine surgery, such as kyphoplasty and vertebroplasty, which is more invasive, is the alternative to conservative management.

Importantly, people with vertebral compression fractures tend to be older. So, doctors have to do a risk versus benefit analysis to decide whether putting the person through invasive surgery is best for their needs.

Balloon kyphoplasty generally delivers good results for people with osteoporotic vertebral compression fractures. The procedure also comes with a low risk of complications.

  • Refracturing: In rare cases, a person who has had kyphoplasty may experience a refracture, or a break of the vertebra the surgeon already operated on.
  • New pain and stiffness: Some people who have had kyphoplasty actually experience new pain and stiffness in their back muscles, including the muscles next to the cemented bone.
  • Increasing strain and cement leakage: When the bone cement hardens, it could increase the strain on other nearby vertebrae, resulting in an even higher fracture risk. Other rare complications include cement leakage or damage to the spinal cord.
  • Subarachnoid hemorrhage: One 2022 case report involving an 80-year-old man described a subarachnoid hemorrhage, bleeding around the brain, and delayed paralysis following a kyphoplasty. However, paralysis is an extremely rare complication of kyphoplasty.
  • Pulmonary embolism: Additionally, between 2–26% of people with kyphoplasty experience leakage of cement. The cement could travel to the lungs and cause a pulmonary embolism, or a blocked blood vessel in the lungs.
  • Infections and wasting bone tissue: Rarely, some people get infections following kyphoplasty, while others experience the wasting of bone tissue.

Secondary fractures

A 2022 study found that 21.7% of people who had kyphoplasty for a vertebral compression fracture went on to experience a new fracture. Independent risk factors for having another fracture included:

  • a low Hounsfield unit value, which is a measure of bone density used with CT scans
  • cement leakage
  • fracture of the thoracolumbar junction, which is located between the 12th thoracic vertebra (T12) and the first lumbar vertebra (L1)

Additionally, a retrospective 2019 study concluded that the risk of having a secondary fracture following kyphoplasty increased with older age and lower bone mineral density. Conversely, more outdoor activity reduced the risk of a secondary fracture.

The key to managing ongoing back pain following a kyphoplasty procedure is careful monitoring. The authors of the 2017 case report mentioned above recommended strict follow-up of people who experience pain after kyphoplasty.

People with an osteoporotic compression fracture and who have a cavity inside the fractured vertebra need early diagnosis and treatment of the ongoing issue. This may help prevent refracture of the cemented vertebra after a kyphoplasty.

The researchers also strongly recommended using a back brace and taking osteoporosis medications.

A vertebral compression fracture can leave a person with back pain and difficulty moving. Kyphoplasty is a surgical procedure that involves inflating a balloon to open up the space inside a fractured vertebra so that a surgeon can repair it with special bone cement.

Some people experience procedure complications, including continued back pain, bone cement leakage, or infection. Careful medical monitoring may help identify any issues early so a person can receive the follow-up treatment they need.