Percutaneous vertebroplasty (PVP) is a minimally invasive spinal surgery technique in which bone cement is injected percutaneously into the vertebral body via the pedicle or extra-vertebral root to increase strength and stability, prevent collapse, relieve pain, and even partially restore the height of the vertebral body. This procedure was first performed in 1984 by Galibert and Deramond at the Department of Medical Radiology, University of Amiens, France, where a patient with cervical 2 vertebral hemangioma was successfully treated with percutaneous injection of polymethyl-methacrylate PMMA. The authors concluded that painful osteolytic vertebral metastases without periprosthetic invasion are one of the best indications for percutaneous vertebroplasty. 1994 PVP (applying Deramond’s method) was first introduced to the United States by the University of Virginia. Since that time, PVP has become a common method for the treatment of painful vertebral disorders. The application of percutaneous vertebroplasty has gradually spread and is more often used in patients with osteoporotic vertebral compression fractures with intractable pain, in addition to spinal hemangiomas, myeloma, and osteolytic metastases. As the survival time of patients with tumor metastases increases, so does their quality of life and the requirement to be able to be active in the final stages of the disease. In patients with spinal metastases, PVP has been reported to relieve pain and structurally strengthen the osteolytically damaged vertebrae, allowing patients to experience less pain and to continue daily weight-bearing activities. European experience has focused on the treatment of tumor-related pain (both benign and malignant), while American experience has focused on the treatment of pain associated with osteoporotic compression fractures. Percutaneous kyphoplasty (PKP) is a modification and development of percutaneous kyphoplasty. In 1999, Mark Reiley, an orthopedic surgeon at Berkeley, developed an expandable bone expanding balloon (KyphXTM , Inflatable Bone Tamp), which uses This technique uses a percutaneous puncture of the vertebral body to reposition the vertebral body and create a space inside the vertebral body, which reduces the pushing force required to inject the bone cement and makes it less likely to flow. Compared with conventional methods, there is no difference in biomechanical properties between the two, and clinical application shows that it not only relieves or alleviates pain symptoms, but also significantly restores the height of the compressed vertebral body, increases the stiffness and strength of the vertebral body, restores the physiological curvature of the spine, and increases the volume of the thoracoabdominal cavity and improves the function of the organs, thus improving the quality of life of patients. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty are widely performed worldwide. They are mainly used for the treatment of osteoporotic vertebral compression fractures and osteolytic vertebral tumors, with pain relief rates exceeding 90% for both osteoporotic vertebral compression fractures and vertebral hemangiomas, and over 80% for metastatic tumors, with few serious complications. Their good efficacy and high safety have been recognized by the majority of doctors and patients. The treatment mechanism Bone cement injected into the vertebral body enhances the strength and stability of the vertebral body and relieves pain. After vertebroplasty for compression fractures in osteoporotic patients, it significantly increases the stability of the anterior column and reduces the stress acting on the vertebral arch, which ultimately leads to enhanced stability after osteoporosis, burst fractures and internal fixation of the vertebral arch. Minute fractures of the vertebral body and micromovement of the fracture line produce irritation of the nerve endings in the vertebral body causing pain, and percutaneous vertebroplasty can produce excellent pain relief in such cases, and in this sense, percutaneous vertebroplasty is a fracture repair technique and not just a mere filling of the vertebral body. Almost all clinical results show pain relief rates of more than 90% in patients with either osteoporotic compression fractures or old thoracolumbar fractures, whether treated. In vertebral tumors, the mechanical effect of injecting bone cement can interrupt local blood flow, and its chemical toxic effect and polymerization heat can also cause necrosis of nerve endings in tumor tissue and its surrounding tissues to achieve pain relief, and even have the effect of killing tumor cells to some extent in a sense. Indications: Vertebral body tumor is the earliest object of percutaneous vertebroplasty, which has achieved very good results. Its applicable objects are: 1, vertebral body hemangioma 2, myeloma 3, primary and metastatic malignant tumors of the vertebral body 4, some benign tumors of the vertebral body Benign tumors of the vertebral body are indicated by benign tumors causing pain due to fracture collapse of the vertebral body, including eosinophilic granuloma and vertebral body lymphoma. Malignant tumors of the vertebral body, mainly osteolytic in nature, can be stabilized by intravertebral injection of PMMA in addition to simultaneous biopsy of the tumor tissue for definitive diagnosis. For vertebral hemangioma, percutaneous vertebroplasty can increase the strength of the vertebral body and provide pain relief and embolization of the tumor; if necessary, posterior decompression of the vertebral plate can be performed without vertebral body resection, which simplifies the surgery. Laredo et al. classified hemangiomas into two categories: invasive and potentially invasive, based on their imaging performance. The main imaging manifestations of hemangioma are irregular fenestrations of vertebral trabeculae, which may involve the entire vertebral body and the vertebral arch, with well-defined or ill-defined margins, which may break through the bone cortex and extend into the epidural space. Vertebral hemangiomas are divided into the following groups according to clinical and imaging manifestations: (1) hemangiomas with negative invasive signs but painful symptoms; (2) hemangiomas with invasive imaging signs but no clinical symptoms; (3) hemangiomas with both invasive imaging signs and clinical symptoms; and (4) hemangiomas with invasive imaging features and spinal nerve compression symptoms. The first group is the selective indication for PVP, and Deramond et al. reported that 90% of the cases were relieved and no recurrence of hemangioma was found; the second group is the best indication for PVP; the third group of hemangiomas should be injected with anhydrous alcohol instead of bone cement to harden the hemangioma and strengthen the weight-bearing capacity of the vertebral body, and most of the patients’ neurological symptoms gradually disappeared, and some cases can be found on imaging follow-up The epidural mass disappears in some cases; PVP for group IV hemangiomas is only an adjunct. N-butyl cyanoacrylate resin was injected into the PVP lesion one day before the conventional surgery to embolize the hemangioma, reducing intraoperative bleeding and making the surgical operation easy to perform. Metastases and myeloma are the most common osteolytic malignancies of the spine, often causing severe back pain and loss of mobility. Treatment depends on the number and location of affected vertebrae, the degree of intradural involvement, the presence of neurological symptoms, the general condition of the patient, the degree of pain, and the degree of mobility restriction. Widely used radiation therapy can relieve the symptoms of more than 90% of patients, but it usually takes 10-20 days to show the effect and cannot maintain the stability of the vertebral body, and the tumor can still recur in the vertebral body after radiation therapy. The best indication for PVP in spinal malignancies is severe local pain caused by malignant tumors, restricted activity requiring bed rest, relief by analgesics, and no intradural dural structure invasion; with vertebral compression fractures, the vertebral body maintains at least 1/3 of its normal height and the posterior cortical part of the vertebral body need not be intact. Because of the tendency of vertebral malignancies to develop compression fractures, PVP treatment is a better approach even if the patient is asymptomatic. According to the data, more than 80% of the patients with PVP treatment had obvious relief of symptoms and improved quality of life. The application of PVP for vertebral malignancies can be followed by adjuvant radiotherapy to consolidate the efficacy, because radiotherapy does not affect the physical and chemical properties of bone cement. Myeloma is often multifocal and multi-segmental resection and fusion is not possible. 90% of patients have pain relief or elimination only 10-14 days after the start of radiotherapy, and radiotherapy weakens bone reconstruction, which often starts only 2-4 months after radiotherapy, and patients with myeloma have an increased risk of nerve compression due to easy collapse of the vertebral body after radiotherapy. PVP provides immediate pain relief and increases the strength and stability of the spine, while PVP can immediately relieve the pain, increase the strength and stability of the spine, and correct the posterior convexity deformity caused by the collapse of the vertebral body, which greatly improves the quality of life of tumor patients and facilitates further chemotherapy and radiotherapy. Absolute contraindications: (1) uncorrected coagulation disorder and bleeding constitution; (2) allergy to any items required for the procedure. Relative contraindications: (1) pain of a radical nature that significantly exceeds that of the vertebral body, caused by a compression syndrome unrelated to vertebral body collapse; (2) tumor extension into the epidural space and significant spinal canal compression; (3) difficulty in performing vertebroplasty when there is extensive destruction of the vertebral body or severe vertebral body collapse (less than 1/3 of the original height); (4) osteogenic tumors; (5) simultaneous treatment of three or more than one segment at a time. In the United States, percutaneous vertebroplasty and kyphoplasty are more commonly used in patients with osteoporotic vertebral fractures. Indications: (1) painful osteoporotic vertebral compression fractures that have failed to respond to pharmacologic therapy; (2) painful vertebral fractures associated with osteonecrosis; (3) unstable compression fractures; (4) multiple osteoporotic vertebral compression fractures resulting in a retroconvex deformity with pulmonary and gastrointestinal effects and altered center of gravity; (5) chronic traumatic fractures with nonunion or (6) Acute traumatic fractures without neurological symptoms. Absolute contraindications: (1) asymptomatic stable fractures; (2) patients with significant improvement after pharmacologic treatment; (3) prophylactic treatment in patients without evidence of acute fracture; (4) uncorrected coagulation disorders and bleeding diathesis. (5) Osteomyelitis in the target vertebrae; (6) Hypersensitivity to any of the items required for the procedure. Relative contraindications: (1) radicular pain that significantly exceeds that of the vertebral body, caused by a compression syndrome unrelated to vertebral body collapse; (2) significant spinal canal compression due to regression of the fracture mass; (3) severe vertebral body collapse; (4) painless stable fractures that are more than 2 years old; (5) 3 or more segments treated simultaneously at one time.