Symptomatic Cord Compression is an absolute contraindication to kyphoplasty.  However, retropulsion is not, and can even make things better and avoid an operation — as this case shows. The problem is that its unpredictable and one has to be extremely careful…

Patient presents with severe acute T11 fracture.  There are some chronic ones also — very bad T9 and just bad T10

Pre-procedure CT scan

MRI and CT on the top.  Lateral projection xray and DYNA CT reconstruction during kyphoplasty on bottom.  There is tremendous spontaneous reduction of T11 compression fracture — due to prone positioning.   Also notice fracture of the pedicle

Sagittal views of DYNA CT — height restoration, pedicle fractures

Post kyphoplasty DYNA CT — intentional extension of cement into the pedicles to help stabilize the fracture

Post-kyphoplasty MRI — reduction of posterior fragment extension into the spinal canal with improved cord compression

Does not happen every day — one could not tell for example from the CT or MRI how much reduction, if any, would happen in prone position.  But, if it does, the results can be excellent