Fractures in the vertebrae can cause chronic pain and impair mobility. These fractures can occur due to injury or as a result of certain medical conditions, such as compression fractures commonly associated with osteoporosis. If you or your doctor are reviewing treatment options for pain management due to a vertabral fracture, kyphoplasty may be considered. Medicare benefits may be available for this procedure when certain requirements are met.
Overview of How Kyphoplasty Works
Kyphoplasty is a type of vertebral augmentation that uses bone cement to stabilize and restore the structure of certain types of fractured vertebrae. To inject the cement into the appropriate area, a surgeon inserts a balloon that is then inflated to lift the broken vertebra so that a cavity can be made for the bone cement to fit inside.
Generally, this procedure is performed by a surgical specialist as an outpatient service, which means patients are able to return home to recover after the surgery. Patients receive mild sedation and local anesthetics before the procedure, although the treatment can be performed with only a local anesthesia if a patient is unable to tolerate sedatives or has other medical needs that prevent their use.
Side Effects and Risks Associated with Kyphoplasty
In a study performed by the American Society for Bone and Mineral Research, certain patients with compression fractures due to osteoporosis had received a placebo treatment instead of kyphoplasty. They reported pain relief at a similar rate as patients who had received kyphoplasty, which suggested that the treatment itself may not be necessary for some patients.
Severe risks to patients for whom this treatment is deemed medically necessary and appropriate are considered extremely rare. These side effects may include infection or paralysis, as well as tingling sensations, numbness and possible headaches. A misplaced needle or bone cement is typically the cause of these issues, but radiological imaging devices during the procedure help reduce the chance of this happening.
While also rare, there are some risks associated with the bone cement material, such as an allergic reaction to the chemical compounds of the material, as well as leakage of the cement into the tissues and bloodstream, or an embolism due to pressure caused by the placement of the bone cement.
Your healthcare professional can help you determine if you are at a greater risk than others for any side effects or problems related to kyphoplasty. Discuss any previous medical complications or known allergies with them before the surgery.
Medicare Coverage for Kyphoplasty
Medicare recipients who have Part B coverage may be able to apply these Medicare benefits towards the cost of kyphoplasty if your doctor determines that the procedure is medically necessary. In order to reach this determination, your doctor may advise you to try other treatments first. This may include prescription medication to help slow bone loss or devices like back braces to relieve pressure along the spine.
While Part B Medicare benefits cover outpatient services like kyphoplasty, qualifying for coverage may require extensive documentation of your condition and treatments used to relieve the pain. There may also be restrictions on which specialists and outpatient facilities can perform the procedure. Additionally, proof of a follow-up treatment plan may also be required. The monthly premium for Part B and all other cost-sharing obligations, such as deductibles, coinsurance, and copayments, must be paid for coverage to apply.
Additional coverage may be available through a Medigap plan that helps cover some of the costs that Original Medicare does not, such as deductibles, coinsurance and copayments. Medicare Advantage plans will include the same Part A and Part B benefits as Original Medicare, but many help Medicare recipients reduce their out-of-pocket costs for in certain circumstances. Each insurer provides a different set of benefits, so check with a representative to determine which plan works best for your needs.