The sooner the better, in my opinion.  You will want to have an MRI showing that there is still edema on T2-weighted images.  If there isn't, you may be dealing with a  healed fracture and fixed deformity...and kyphoplasty may not help the patient.

Dear Dr William do yiu try conservative treatment first or you go directly to kyphoplasty .if you try conservative tratment for how long ? 

Dear Fadi

Vertebroplasty and kyphoplasty will not improve old and chronic fractures, nor will they reduce back pain associated with poor posture and stooping forward. Traditional treatment used to involve waiting 4 to 6 weeks to see if patients improved on their own, but now it's believed that waiting allows the bone to harden, making vertebroplasty or kyphoplasty less effective. Many authors are now suggesting vertebroplasty as soon as the first week after a fracture for some patients because the results are significantly better.

This article may be useful for you:

 Wong W, Reiley MA, Garfin S: Vertebroplasty/Kyphoplasty. J Women's Imaging 2(3):117-124, 2000

I agree with dr.Wiliam: the sooner the better!

To be effective a kyphoplasty should be done in fresh fractures. Unfortunately, this is not always the case and this compromises this method.

I agree to my preceding colleagues concerning the optimal pont of time performing such a minimally-invasive-procedure. The "plasticity" of a only a few weeks old vertebral compression fracture sometimes allows restoration of the vertebral body height and form.

Absolutely vital, in my opinion, is the correct indication and patient selection.

If you inform them that:

1) kyphoplasty aims to relieve pain, but can not guarantee any kind of stability

and

2) conservative treatment is a considerable option in most cases

and

3) leg pain or numbness is not caused by the VCF and therefore not expected to improve

then you may have great success and grateful patients.

Furthermore, you should consider some technical aspects like the volume of applied bone cement and its relationship to pain relief as.

Last, but not least, kyphoplasty seems sometimes to be a good option for  treatment of symptomatic metastatic cancer in the spine with the additional option for simultaneous biopsy.

Dear Fadi,

 It is not a simple question to be answered to.

The problem arises from the discrepancy between the old guidelines for vertebroplasty and the clinical practice of kyphoplasty.

The indication for the vertebroplasty is a fracture still painful 2 months after the onset, with persistent edema in the MR stir images.

The clinical practice and some papers in meeting sessions about kyphoplasty indicate that an early kyphoplasty can better reduces the deformity of the vertebral bodies, than a surgery after 2 weeks. You can hear an interview performed in the session about kyphoplasty in the 2011 ESCEO meeting in  Valencia at the url: http://www.md-fm.com/live-from-ecceo-2011-saturday-26th-march-2011-689.html#.

My personal suggestion is to perform the kyphoplasty between 5 and 14 days after the fracture onset, like a fracture in other sites were there is predominantly trabecular bone (proximal tibia for example). Before 5 days there is some more risk of cement lacking or infection because the inflammatory response is still very high. After 14 days the chances of a restoration of the vertebral height decrease very rapidly.

 Other suggestion is to peform always MR and CT scans. The first to be sure to treat the right vertebra (that with edema) and discover eventually adjacent impending fractures. The second to be sure that the posterior vertebral wall is intact. A bone biopsy during the procedure allows also to be sure that the fracture is due to pure fragility and not to an underling undiagnosed neoplastic lesion (metastatic or myeloma), that it is not so infrequent.

A last suggestion, that in my opinion is the most relevant, don't forget to treat the osteoporosis with correct pharmacological treatment. In first you have to exclude that the osteoporosis is a secondary form, only performing simple laboratory tests. Secondarly you have to correct the vitamin D deficit, often present, and finally to prescribe an antifracturative drug. Bisphosphonates in the less severe forms, denosumab or teriparatide in more sever cases. Teriparatide is the only anabolic treatment for bone and give the better results after a vertebral fracture, unfortunately it is very expensive.

Luca

soon.. in few days

The sooner the better.However if your vertebroplasty team is not experienced enough conservative treatment may be a better option.Most of the osteoporotic vertebra fractures heal spontaneously (healing means pain relief and functional independency, not restoration of kyphosis or vertebra height) in one month .

According to our guidelines kyphoplasty is indicated for persistent painful osteoporotic fractures, after 3 weeks and documented conservative therapy!

VAS >5

To my opinion you need to exclude instability (CT)! And you need MRI to evaluate the "age" of the fracture an to exclude/find occult fractures

To colleagues above :  I would like to know what is the sense to wait 3 weeks and see if the conservative treatment works ? Why 3 weeks, and not 6 weeks for example ? Why at first classic conservative treatment ? Is it the fear from complications of vertebroplasty/ kyphoplasty ?

It depends on the antiquity of fracture is advisable to perform an MRI if there is edema in the vertebral body kyphoplasty can be done on many occasions in patients with multiple fractures it is difficult to date the fracture. in any case it must be done as soon as possible because it is easier to get a good correction

I DUN THINK THERE IS ANY SPECIFIED DATA IN LITRATURE TO SUPPORT THE KYPHOPLASTY PROCEDURE TIMING IN OSTEOPOROTIC PATIENTS, RATHER THE POTENTIALLY WEEK AND OSTEOPOROTIC VERTEBRA CAN BE TAKEN UP FOR KYPHOPLASTY , DEPENDING UPON THE EXPERTISE, OF CONSULTANT.