Thoracolumbar fracture is a common clinical disorder in spine surgery, and with the development of modern spine surgery concept, more and more patients need to receive surgical treatment, and the structure and function of the spine can be restored after surgery, but there are always some patients who often have residual low back pain after surgery due to complications such as loss of height after fracture reduction and endplate collapse, which bring inconvenience to the patients’ working life. How to improve the efficacy and reduce the sequelae after thoracolumbar fracture has become one of the challenges faced by spine surgeons today [1]; meanwhile, along with the increase in the proportion of elderly population and the change in people’s lifestyle, patients with osteoporotic vertebral compression fractures (OVCF) are The number of patients with osteoporotic vertebral compression fractures (OVCF) is increasing year by year, and vertebral compression fractures with severe pain are a common medical problem worldwide. The physiological characteristics of the spine determine that the anterior edge of the vertebral body of the thoracolumbar junction and the mid-thoracic segment is vulnerable to compression, and when the bone density decreases, the greater the shear force on this area, the easier it is to compress, so clinically, compression fractures of the vertebral body of the thoracolumbar and mid-thoracic segments are the most frequent sites of the spine. In 1994, Reiley et al. designed and developed an expandable balloon, which was placed into the vertebral body by percutaneous puncture, and the balloon was expanded to restore the height of the vertebral body and correct the kyphoplasty, so the technique was called kyphoplasty, and was approved by the FDA for clinical use in 1998 [ 4-6 ]. Kyphoplasty is actually a variation of vertebroplasty and a development of vertebroplasty [5]. In recent years, scholars have begun to conduct research on vertebroplasty and vertebral body kyphoplasty for osteoporotic vertebral fractures and traumatic thoracolumbar fractures, actively expanding the clinical application of this technique [7-9]. Percutaneous vertebroplasty and vertebral kyphoplasty provide rapid pain relief and early functional exercise, making surgical treatment of localized osteoporosis possible and providing time and opportunity for subsequent pharmacological counterfactual treatment of osteoporosis. The efficacy of vertebroplasty and kyphoplasty has been reported extensively in the domestic and international literature. Yang Huilin et al [10] used vertebral body kyphoplasty to treat 30 cases of osteoporotic vertebral compression fractures of 56 vertebrae in the elderly, and the results showed that vertebral body kyphoplasty could effectively improve the physiological function of patients with osteoporotic compression fractures, relieve pain, correct the kyphotic deformity of the spine due to vertebral compression fractures, and restore the spinal sequence. The majority of thoracolumbar fractures are treated surgically with a posterior closed-repositioning pedicle nail rod system for fixation. This surgical approach is less invasive, satisfying in repositioning, secure in fixation, and relatively safe in operation, and the transpedicular internal fixation technique is still considered to be one of the ideal methods for thoracolumbar fractures. However, posterior surgery fails to restore the height of the injured vertebral body while restoring the compression-damaged trabeculae to their original trabecular structure, resulting in an “Eggshell-like” change in the vertebral body. In particular, in burst fractures, endplate rupture often occurs and the disc and fractured endplate are extruded into the vertebral body, resulting in loss of structural integrity of the anterior middle column. The injection of cancellous bone into the vertebral body via the pedicle was once popularized, but some studies by Knop et al [11] and Alanay et al [12] showed that this method did not reconstruct the strength and stability of the vertebral body and did not reduce the incidence of internal fixation failure and loss of correction.Mermelstein et al [7] demonstrated through experimental studies that, in combination with repositioned internal fixation by the posterior pedicle screw system, the Mermelstein et al [7] demonstrated that vertebroplasty with intra-vertebral injection of calcium phosphatecement (CPC) via the pedicle into the injured vertebral body can effectively enhance the stability of the anterior column of the injured vertebral body. In a study by Xu Baoshan et al [13], it was also shown that the application of CPC for vertebroplasty contributed to the reconstruction of the injured spine, and the biomechanical properties of the postoperative spine were close to the pre-fracture level.In a group of preliminary clinical application reports, Verlaan et al [14] showed that in 20 patients with thoracolumbar burst fractures without neurological injury, after repositioning and fixation with a posterior pedicle screw system within 1 week after injury, the injured spine was repaired via bilateral pedicles through The results showed that CPC was well distributed in the injured vertebral body, and the central and anterior heights of the injured vertebrae were restored by 78% and 91%, respectively, and there was cement leakage in 5 cases, but it did not cause clinical discomfort, indicating that balloon-expanded vertebral body kyphoplasty for thoracolumbar burst fractures can restore vertebral body height and reconstruct the boundaries of the intervertebral space, which is a safe and reliable method. Xu Baoshan et al [9] performed vertebroplasty with injectable self-curing CPC via the injured vertebral arch under C-arm X-ray fluoroscopy in 21 patients with severe thoracolumbar fractures after applying posterior incisional repositioning short-segment pedicle screws for internal fixation, with an average follow-up of 13 months after surgery, with no aggravation of neurological symptoms or appearance of new neurological symptoms and satisfactory results, without internal fixation failure and significant loss of injured vertebral height. Vertebroplasty and kyphoplasty are relatively safe procedures, and post-injection leakage is the most common complication. Leakage is most often caused by the puncture needle breaking through the inner edge of the pedicle or the posterior edge of the vertebral body, over-injection of bone cement, or too dilute bone cement. The destination of bone cement leakage is related to the anatomical structure of the spine, including leakage to the paravertebral soft tissue, intervertebral space, epidural, intervertebral foramen and vertebral venous plexus. Leakage of bone cement into the paravertebral soft tissues, although more common, is not clinically significant. Leakage of bone cement into the intervertebral space, although not acutely symptomatic, has a mechanical effect on the adjacent vertebral body, potentially increasing its fracture incidence. Leakage into the epidural and intervertebral foramina may produce symptoms of spinal cord and nerve root compression; leakage into the vertebral body or paravertebral veins may cause pulmonary embolism. In recent years, with the progress of research related to vertebroplasty, the incidence and severity of bone cement leakage have been effectively controlled, and high viscosity bone cement combined with pressure pumps can be used to reduce bone cement leakage, and a new Vessel-X mesh bag-shaped bone expander developed by Zheng et al [15] can be used to better control the distribution of bone cement in the vertebral body, etc. Secondary filling techniques can also be used to to reduce the leakage of bone cement into the intervertebral disc. The puncture route of vertebroplasty: clinically, the puncture route of vertebroplasty can be divided into bilateral and unilateral arch root punctures. In order to achieve symmetrical distribution, many physicians use a bilateral arch root approach. However, perfusion of the vertebral body via the bilateral arch increases the chance of arch fracture, tissue trauma, and neurovascular injury, as well as the operative time and exposure time under X-ray, and the 1st injection of bone cement interferes with the observation of the 2nd perfusion. In order to shorten the procedure time, save the cost of the procedure (only one former is used), make the procedure safer and reduce the patient’s pain. Many authors advocate a unilateral approach to vertebroplasty in order to reduce the exposure time of the surgeon and the patient to X-rays. In the lumbar spine, enlargement of the camber angle allows insertion of the puncture needle into the anterior 1/3 of the diseased vertebral body, whereas in the thoracic spine, due to the small camber angle of the thoracic arch, the unilateral puncture injection does not allow good filling of the bone cement across the midline.Kim et al [16] achieved the right position of the needle tip (30 degrees for lumbar camber and 20 degrees for thoracic camber) by proper manipulation, and the puncture needle The pain relief effect was not statistically different between the two. In China, Kangnan et al. used unilateral arch root puncture vertebral body kyphoplasty to treat osteoporotic vertebral compression fractures (T8-L3) with satisfactory results [17]. Zeng Yong et al [18] used unilateral puncture method of percutaneous kyphoplasty to treat 30 cases of osteoporotic vertebral compression fractures with satisfactory results.In 2007 Chang ws [19] authors in Seoul, Korea reported the application of individualized puncture angle (NIA) proposed for the treatment of thoracic vertebral compression fractures through a transcostal joint approach vertebroplasty Compression fractures: the entry point of this approach is located at the lateral end of the transverse process of the thoracic spine, and the needle is guided to the anterior 1/3 of the thoracic vertebral body via the cribriform joint by increasing the external inclination angle, and this method has achieved good clinical efficacy. Ryu KS et al. applied [20] to treat osteoporotic thoracic compression fractures via the unilateral costo-transverse joint route, with the patient in prone position and its entry point located 1 cm outside the left costo-transverse joint (costo-transverse joint), and the puncture needle was maintained at an inclination angle varying from 45° to 50° to the horizontal plane via The needle is inserted into the target area of the anterior 1/3 of the diseased vertebral body through the “thoracic arch-rib space”, and good therapeutic effect is obtained. In China, Ma Xin et al. of Huashan Hospital [21] pointed out the safe range of fluoroscopic tube ball tilt angle with the reference to the inner wall of the vertebral arch and the safe range of oblique fluoroscopic positioning to guide the posterior lateral thoracic vertebral body puncture and the operation method, and the oblique fluoroscopic guidance of the posterior lateral thoracic vertebral body puncture with the reference to the inner projection of the vertebral arch is a feasible unilateral thoracic vertebral body puncture method. In conclusion, vertebroplasty is now widely used in spine surgery, not only for the treatment of osteoporotic vertebral fractures, but also as an adjunct to the posterior arch root puncture vertebral fracture reduction of injured vertebrae in traumatic thoracolumbar fractures.