Kyphoplasty

A good candidate has a recent, painful compression fracture that has not healed and is causing significant pain or loss of function. Medicare in New York looks for an osteoporotic fracture up to 12 weeks old, bone marrow edema on MRI or activity on a bone scan, and severe pain or moderate-to-severe pain despite non-surgical care^[1]. Your pain must come from the fracture rather than from a disc, arthritis or stenosis^[9].

Kyphoplasty should not be done when the back pain is not caused by the fracture, or when there is a spinal infection, an active infection elsewhere or pregnancy^[1]. A spine surgeon’s opinion is usually needed if bone fragments have moved into the spinal canal, the spine is unstable or the fracture is causing new weakness or numbness^[1]. Uncorrected bleeding problems and cement allergy are also reasons to avoid or delay it.

Sometimes, if the fracture has not healed. The procedure is intended for symptomatic, non-healing fractures^[8], so an MRI is used to look for bone marrow edema, a sign the bone is still unstable. Medicare in New York covers osteoporotic fractures up to 12 weeks from the start of symptoms^[1], so older fractures may face coverage limits. A fully healed fracture usually does not benefit, and remaining pain may have another cause.

The procedure itself usually takes less than an hour for each vertebra treated^[9]. Plan to spend a few hours at the facility in total, including check-in and recovery. With moderate sedation or general anesthesia you should not feel sharp pain during the procedure, though you may be sore for a day or two afterward^[9].

Preparation usually includes an exam, spine imaging, a medication review and sometimes blood tests^[9]. Vertebral augmentation is treated as a high bleeding-risk procedure, so blood thinners often need to be paused — but only with approval from the doctor who prescribed them^[10]. Follow the fasting instructions you are given and arrange for an adult to drive you home.

Most people go home the same day and can walk right away^[9]. Soreness where the needles entered is common for a couple of days and usually responds to ice. Avoid heavy lifting until your physician clears you. Call us promptly for fever, increasing pain, or new leg weakness or numbness, and keep your follow-up visit so your bone health can be addressed.

Relief often comes quickly: trials describe kyphoplasty as rapidly reducing pain, with clear benefits by one month^[4]. In the FREE trial, kyphoplasty improved quality of life and back pain more than non-surgical care at one month^[3]. The advantage for back pain lasted through two years, although other differences narrowed over time^[4]. Results vary, especially if some of your pain comes from other sources.

The cement stays in the bone, and later problems at the treated vertebra are uncommon, although the FREE trial reported rare late events such as cement shifting^[4]. The bigger long-term issue is your bones: in the FREE trial, about as many people developed new spinal fractures over two years with kyphoplasty (47.5%) as with non-surgical care (44.1%)^[4]. That is why osteoporosis testing and treatment matter so much — osteoporosis medicines lower the risk of new vertebral fractures by 40–70%^[7].

The main downsides are procedure risks and uncertainty about how much it adds over non-surgical care. Complications are rare but include infection, bleeding, nerve injury and cement leaking outside the bone, which can occasionally travel to the lungs^[9]. Kyphoplasty does not prevent future fractures elsewhere in the spine^[4], and an expert task force has concluded that routine use is not supported by current evidence^[7].

Both inject bone cement into a fractured vertebra, but kyphoplasty first inflates a balloon to create a cavity. That step is associated with less cement leakage and may restore some lost height^[8][9]. Vertebroplasty did not show clinically important benefit over sham procedures^[6]; kyphoplasty has been compared only with non-surgical care. Medicare in New York covers either for patients who meet its criteria^[1].

Most compression fractures are first treated without a procedure: pain medicine, short-term activity changes, sometimes a brace, physical therapy and osteoporosis treatment. Newer augmentation devices, such as vertebral body stents and implants, are also used, but an expert task force found insufficient evidence that kyphoplasty is better or worse than these options^[7]. If pain continues after the fracture heals, facet joint injections or other treatments may be considered.

Medicare covers kyphoplasty for patients who meet its criteria. In New York, National Government Services (renamed Wellpoint Federal in 2026) applies LCD L33569, which covers osteoporotic fractures up to 12 weeks old with edema on MRI and significant pain despite non-surgical care^[1]. Commercial plans usually require prior authorization. For New York workers’ compensation, kyphoplasty requires carrier pre-authorization^[2]; no-fault claims follow their own rules. Our staff verifies benefits before scheduling.