In recent years, the minimally invasive balloon-expanded vertebral retrobulbar kyphoplasty, which was developed and perfected on the basis of vertebroplasty, has obtained encouraging results and opened up a completely new way for the treatment of osteoporotic spinal compression fractures in the elderly. 1, clinical data (1) general data The group of cases totaled 12 cases of 19 vertebrae, 5 men and 7 women; age 58-86 years old, average 71.4 years old. The duration of symptoms was 11 days-2 months, with an average of 24 days. All patients had osteoporotic compression fractures, including 7 cases of single vertebral compression fractures, 3 cases of two vertebral fractures, and 2 cases of three vertebral fractures. Involved segments: T71 vertebra, T8-2 vertebra, T91 vertebra, T102 vertebra, T112 vertebra, T124 vertebra, L14 vertebra, L23 vertebra. None of them had symptoms and signs of spinal cord and nerve root damage before surgery. (2) Clinical manifestations All patients presented with persistent severe low back pain after minor trauma, impaired mobility, and inability to take care of themselves without signs of neurological damage. After taking non-steroidal anti-inflammatory and analgesic drugs and applying drugs for osteoporosis such as migarettes, osteopontin and calcium tablets, the effect was not good, or the pain recurred after short-term improvement. MRI showed that the fractured vertebrae were low signal in acute and subacute (1-30 days) T1-weighted images and high signal in T2-weighted images. The T2-weighted image was high signal, and the chronic phase (after 30 days) showed isosignal in both of these weights. Bone densitometry showed moderate or above osteoporosis. The patient is placed in prone position under local anesthesia, and the balloon is placed via percutaneous puncture in T10-L5, or via paracentral approach in T5-T12. Each vertebral body can be dilated with a single balloon in a unilateral approach or with a double balloon in a bilateral approach. Each step must be performed under the supervision of a digital subtraction angiograph (DSA). The tip of the puncture needle is placed at the outer superior edge of the arch, usually at 10 o’clock on the left side and 2 o’clock on the right side, and is marked with two kerf pins in the orthogonal position. The digital subtraction angiograph (DSA) is set to the lateral position, and the core puncture needle is drilled in. When the needle tip reaches 1/2 of the vertebral arch root, i.e., the orthostatic position shows that the needle tip is located at the midline of the vertebral arch root shadow, drilling can be continued under the lateral fluoroscopy; when the lateral position shows that the needle tip reaches the posterior wall of the vertebral body, the orthostatic position should show that the needle tip is located at the medial edge of the vertebral arch root shadow, indicating that the direction of needle feeding is correct, and drilling can be continued for 2~3 mm and then stopped. The inner core of the puncture needle is withdrawn and the guide needle is placed. The puncture needle is withdrawn and the dilating trocar and working trocar are placed in sequence along the guide needle, so that the front end of the working trocar is located 2~3mm anterior to the posterior cortical margin of the vertebral body. The fine drill is slowly drilled through the working cannula, and when the lateral position shows that the tip of the drill reaches 1/2 of the vertebral body, the orthostatic position should show that the tip of the drill does not exceed 1/2 of the line between the arch root and the spinous process; when the lateral position shows that the tip of the drill reaches the anterior edge of the vertebral body, the orthostatic position should show that the tip of the drill is close to the edge of the spinous process. The fine drill is removed and an expandable balloon is placed, which is ideally positioned in the anterior 3/4 of the vertebral body in the lateral position, tilted from posterior to superior to inferior. The same method is used to complete the contralateral puncture and balloon placement. The injection device is connected and the balloons on both sides are expanded simultaneously. The expansion of the balloons and fracture repositioning are monitored by a digital subtraction angiograph (DSA), and the pressurization is stopped when the vertebral body is satisfactorily repositioned or when the balloons reach the bone cortex around the vertebral body, with the pressure generally not exceeding 300 psi. The balloons are removed and the bone cement in the drawing phase is injected into the vertebral body, which is monitored by a digital subtraction angiograph (DSA), and is stopped when the bone cement is about to spill out of the vertebral body. It was stopped when the cement was about to spill out of the vertebral body. The average amount of bone cement injected into each vertebral body in this group was 4.8 ml. The patients were allowed to lie down for 2 h after surgery and walk on the ground after 12 h. 3. Results All 12 patients had immediate disappearance of pain after surgery, no neurological complications, 5 cases could get out of bed on the same day, 6 cases left bed on the next day, and 1 patient with hemiplegia after cerebral infarction had disappearance of pain after surgery and could move easily and sit in a wheelchair. There were no other uncomfortable symptoms and complications except for 5 cases who reported soreness and swelling in the lower back on the day of surgery. The duration of hospitalization ranged from 7 to 16 days, with an average of 9 days. All 12 patients underwent postoperative X-ray and CT review, and the X-ray films showed satisfactory correction of the posterior convexity deformity and restoration of the height of the injured vertebrae, with the posterior convexity deformity corrected by 10°-27°, averaging 18°. CT showed that the bone cortex around the injured vertebrae was intact, and the bone cement filled in the cavity was located in the weight-bearing area with uniform density. The follow-up ranged from 3 to 12 months, with a mean of 6 months. All 12 patients returned to their pre-injury lifestyle without pain and without morbidity. On imaging review, there was no significant loss of height of the injured spine and no signs of disc degeneration were seen.