Percutaneous vertebroplasty (PVP) is a minimally invasive spine surgery technique that involves percutaneous injection of cement into the vertebral body through the pedicle or external pedicle to increase strength and stability, prevent collapse, relieve pain, and even partially restore the height of the vertebral body. Vertebroplasty has been used for decades as an open procedure to augment the pedicle screw and to fill the defect left after tumor removal. The procedure involves injecting bone tissue or bone cement into the vertebral body to mechanically strengthen its structure. In some cases, the risks of open surgery were too great and stopped the doctor and patient in their tracks, hence the emergence of percutaneous vertebroplasty (PVP). Percutaneous vertebroplasty inherits the advantages of vertebroplasty without the complications associated with open surgery. This procedure was first performed by Galibert and Deramond at the Department of Medical Radiology, University of Amiens, France, in 1984, where a patient with a cervical 2 vertebral hemangioma was successfully treated with a percutaneous injection of polymethyl-methacrylate PMMA, pioneering percutaneous vertebroplasty. Using a slightly modified technique (18G), neuroradiologists and neurosurgeons at the University Hospital of Lyon, France, injected bone cement into the vertebral bodies of 7 patients, 2 of whom had vertebral hemangiomas (VHs), 1 had a metastatic spinal tumor, and 4 had osteoporotic vertebral compression fractures. In 1989, Kaemmerlen et al. reported the use of this technique for the treatment of vertebral metastases. 16 of 20 patients with vertebral metastases achieved significant results, 2 were ineffective, and 2 had complications. The authors concluded that painful osteolytic metastases without periprosthetic invasion are one of the best indications for percutaneous vertebroplasty. In 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 treatment for painful vertebral disorders. The application of percutaneous vertebroplasty has gradually spread in recent years 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. In 2002, 38,000 percutaneous vertebroplasty procedures and 16,000 percutaneous retrobulbar plasty procedures were performed in the United States, mainly for the treatment of osteoporotic vertebral compression fractures, with reported pain relief rates exceeding 90% and few serious complications. They are recognized by the majority of doctors and patients for their good efficacy and high safety. I. Mechanism (a) Enhancement of vertebral body strength Biomechanical testing of vertebral specimens from 40 fresh osteoporotic patients by Bo et al. showed that the axial compression strength and stiffness after vertebral compression fracture were 527±43N and 84±11N/mm, respectively; while the test results after intravertebral injection of calcium phosphate or PMMA showed that the calcium phosphate group was 1063±127N and 157±21N/mm, respectively, and the PMMA group was 10±21N/mm, respectively. mm, and 1036±100N, 156±8N/mm for the PMMA group, respectively, and CT examination showed good intravertebral cement filling, except for the posterior part of the vertebral body, which was 85-95% filled in the calcium phosphate group and 79-90% filled in the PMMA group. It has been shown that intravertebral injection of self-curing calcium phosphate cement (CPC) can significantly restore the mechanical properties of the fractured vertebral body, and the degree of restoration is related to the amount of injected bone cement, which can reach up to twice the strength and about 15% of the stiffness of the original case; after vertebral fracture, the fracture is filled with CPC via the pedicle The strength and stiffness of the vertebral body can also be restored by filling the fracture space and intravertebral space with CPC after vertebral fracture, increasing by 16.67% (P<0.05) and 11.05% (P<0.05) respectively. (Mermelstein found that after vertebroplasty for compression fractures in osteoporotic patients, the compliance of the vertebral motion segment was significantly reduced compared to the preoperative period, with a 23% and 26% reduction in flexion-extension and lateral bending compliance, respectively, but Kifune's study showed a 34% increase in flexion-extension and lateral bending compliance after a vertebral compression fracture compared to the pre-fracture period. Biomechanical experiments on cadaveric specimens have shown that self-curing artificial bone cement injected into the diseased vertebrae via the pedicle can immediately reduce pedicle screw stresses. Mermelstein found a 40% increase in flexion and extension stiffness after internal fixation of burst fractures and calcium phosphate vertebroplasty, and calcium phosphate significantly increased the stability of the anterior column and reduced the stress acting on the pedicle, ultimately resulting in enhanced stability after osteoporosis, burst fractures, and internal fixation of the pedicle. (C), relief of spinal pain Minute fractures of the vertebral body and micro-movement of the fracture line produce stimulation of the nerve endings in the vertebral body causing pain, and percutaneous vertebroplasty can produce excellent pain relief in this case, in the sense that percutaneous vertebroplasty is a fracture repair technique, not just a mere filling of the vertebral body. Almost all clinical results show a pain relief rate of more than 90% in patients with either osteoporotic compression fractures or old thoracolumbar fractures. The reasons for this are not yet known with certainty and may lie in the following: (1) microfractures within the vertebral body are stabilized after vertebroplasty; (2) the bone cement takes up a significant portion of the axial stress, thus reducing the irritation of the nerves within the vertebral body by micromovements of the fracture line. (3) the sensory nerve endings within the vertebral body were destroyed. In the case of vertebral tumor, after injecting bone cement, its mechanical effect can interrupt local blood flow, and its chemical toxic effect and polymerization heat can also cause necrosis of nerve endings in the tumor tissue and its surrounding tissues to achieve the effect of pain relief, and it even has the effect of killing tumor cells to some extent in a sense. Indications and contraindications (a) Indications: 1. Vertebral body tumor is the earliest object of percutaneous vertebroplasty, which has achieved very good results. Its applicable objects are: vertebral hemangioma, myeloma, primary and metastatic malignant tumors of the vertebral body, and some benign tumors of the vertebral body. 2. Painful osteoporotic vertebral compression fractures that are ineffective with drug treatment. 3. Painful vertebral fracture associated with osteonecrosis. 4. Unstable compression fracture. 5. Multiple osteoporotic vertebral compression fractures resulting in posterior convexity deformity and causing pulmonary function, gastrointestinal function effects and change in center of gravity. 6. Chronic traumatic fracture with non-healing fracture or internal cystic changes. 7. Acute traumatic fracture without neurological symptoms. (ii) Absolute contraindications: 1. asymptomatic stable fracture; 2. patients with significant improvement after drug treatment; 3. patients without evidence of acute fracture for prophylaxis; 4. uncorrected coagulation disorder and bleeding body. 5. Target vertebrae with osteomyelitis; 6. Allergy to any items required for the procedure. (c) Relative contraindications: 1. pain of a radical nature and significantly greater than that of the vertebral body, caused by a compression syndrome unrelated to vertebral body collapse; 2. regression of the fracture mass causing significant spinal canal compression; 3. severe vertebral body collapse; 4. painless stable fractures with a duration of more than 2 years; 5. simultaneous treatment of 3 or more segments at one time.