Percutaneous Vertebroplasty (PVP) is a new technique in which bone cement is injected into the vertebral body through a percutaneous puncture needle into the diseased vertebral body to enhance the strength and stability of the vertebral body, prevent collapse, relieve low back pain, and even partially restore the height of the vertebral body. Percutaneous Kyphoplasty PKP is developed on the basis of PVP, in which an expandable balloon bone tamp (IBT) is introduced percutaneously into the diseased vertebral body, which is fully expanded to reposition the fractured vertebral body and form a cavity, and the bone cement is injected to enhance the stiffness and strength of the vertebral body It is a new technique to rebuild the stability of the spine, correct the kyphosis, relieve pain and improve the quality of life of patients. In 1984, French interventional radiologists Galibert and Deramond first applied percutaneous vertebroplasty (PVP) to treat a patient with cervical 2 vertebral hemangioma and obtained good treatment results. The results were good. It was then used to treat six other patients with similar results. The first paper on PVP was published in 1987. In 1988, Duquesnal et al. first applied PVP to treat vertebral compression fractures caused by osteoporosis, and from the mid-1990s to the beginning of the 21st century, PVP became popular in several countries for the treatment of osteoporotic compression fractures, with satisfactory results. This technique was first introduced in China in 2000 by the Second Hospital of Sun Yat-sen University. In 1994, American scholars Lieberman and Dudeney based on PVP. In 1998, the technique was approved by the FDA for clinical use, and it was found that this technique could better restore the height of the vertebral body than PVP and greatly reduce the leakage rate of vertebral bone cement. Research and development of bone cement filling materials The filling materials used for vertebroplasty were first used as polyacetylmethacrylate (PMMA), which is the traditional bone cement. It has been widely used by orthopedic surgeons in extremity arthroplasty and has high strength and hardness. Early clinical application in vertebroplasty was very effective. However, it is also found that PMMA can damage the surrounding tissues once leakage occurs due to high polymerization temperature, and it does not combine with the injured vertebral bone, has no bone growth induction effect, bone tissue cannot grow in, and the hardness of the vertebral body after forming increases, which can easily cause the risk of secondary fracture of the adjacent vertebral body. Therefore, a variety of filling materials have been introduced to replace PMMA. For example, Calcium Phosphate Cement (CPC), Hydroxyapatite (HAC), Carbonated Apatite Cement (CBC), Bone Cement Glass-Ceramic Reinforced Matrix Complex (BisGMA/TEGDMA), and Bone Cement Glass-Ceramic Reinforced Matrix Complex (BisEMA/TEGDMA). BisEMA/TEGDMA) and absorbable injectable calcium phosphate bone cement, porous natural granular coral-like substance, etc. The main purpose is to make the filling material closer to the normal vertebral biomechanical properties, while inducing bone growth, bone ingrowth, and the ability to be replaced by new bone by resorption in vivo, and with low polymerization temperature, high viscosity and low leakage. III. Bone cement infusion volume and pain relief mechanism Clinical reports indicate that there is no significant correlation between bone cement infusion volume and clinical outcome, and even less than 30% filling rate of vertebral body can lead to stabilization of fractured vertebrae and reduction of pain. Liebschner et al. showed that the initial stiffness of the diseased vertebra could be restored by injecting 3.5 cm3 of bone cement. Since vertebroplasty was performed, clinical reports have consistently found significant pain relief. However, the mechanism of pain relief is still unclear, and it is generally believed that the possible mechanisms are mainly thermal, mechanical and chemical: 1) the polymerization of the injected cement releases heat to destroy the sensory nerve endings of the affected vertebrae; 2) the injection of the cement mechanically stabilizes the affected vertebrae and fixes the fracture, thus relieving the intractable pain; 3) the chemical nature of PMMA itself destroys the sensory nerve endings of the vertebrae Therefore, it is believed that PMMA cannot be completely replaced at present. 4, surgical indications (a), vertebroplasty indications 1, osteoporotic vertebral compression fracture caused by intractable pain; 2, vertebral destruction caused by benign and malignant tumors, pain caused by compression fracture; 3, vertebral fracture does not heal or cystic change; 4, painful vertebral fracture with osteonecrosis. (B) the indications for vertebral body kyphoplasty is the same as vertebroplasty, because vertebral body kyphoplasty can significantly restore the height of the vertebral body, so it can also be used for unstable thoracolumbar compression fractures. V. Contraindications to surgery (a) absolute contraindications 1. coagulation dysfunction; 2. osteomyelitis of the vertebral body; 3. allergy to PVP instruments or materials. (2) Relative contraindications 1. vertebral fracture line crossing the posterior edge of the vertebral body with bone destruction and incompleteness; 2. severe vertebral fracture with vertebral compression exceeding 75%; 3. severe heart disease, extreme weakness and inability to tolerate surgery; 4. arch fracture; 5. full force infection; 6. vertebral fracture combined with nerve injury; 7. more than 3 vertebral bodies at a time requiring treatment; 8. painless vertebral body Compression fracture. Pre-operative preparation: all patients are routinely subjected to frontal and lateral X-ray and CT scan before surgery, and MRI examination if necessary. 2. Position: different positions according to the location and type of disease, usually prone; 3. Anesthesia: local or general anesthesia; 4. The cervical puncture is performed through the medial edge of the sternocleidomastoid muscle and the carotid sheath enters the vertebral body medially and obliquely. In the thoracolumbar spine, the trans-archal approach is chosen whenever possible, with the tip of the puncture needle placed at the outer superior edge of the arch projection, i.e., at the 2 or 10 o’clock position. When the tip of the needle reaches 1/2 of the vertebral arch, the fluoroscopic orthopantomogram shows that the tip of the needle is located at the midline of the arch root shadow, which indicates correct needle entry. Continue to drill along the arch root. (3) The tip of the vertebroplasty puncture needle should stop in the lateral position to reach the anterior middle 1/3 of the vertebral body. The puncture needle core is withdrawn and the prepared bone cement is injected into the vertebral body with a syringe under fluoroscopy along the trocar, and the injection is stopped immediately once intraoperative fluoroscopy reveals leakage of bone cement. The general injection volume for a single vertebral body is 3-6 ml. (4) Posterior vertebral body kyphoplasty The puncture needle is stopped in the lateral position showing that the front end of the working trocar is located 2-3 mm in front of the posterior border of the vertebral body cortex, i.e. the tip of the needle is located 5 mm in front of the posterior border of the vertebral body cortex. the needle core is removed and the vertebral body drill is drilled into the vertebral body along with the working trocar to the required depth. The balloon is fed into the lone star channel of the diseased vertebral body along the working trocar, and fluoroscopy confirms that the balloon should extend completely into the working trocar, i.e. the marker rings on both sides of the balloon are located at the working trocar. The balloon is slowly expanded by injecting contrast agent under X-ray surveillance, and the pressure is gradually increased until the balloon is satisfactorily expanded, generally not exceeding 300 Pa. The increase in pressure is stopped when the balloon has expanded to the vertebral body to achieve the expected repositioning effect or reached the endplate and surrounding cortex of the vertebral body. After both balloons are satisfactorily dilated, the contrast agent in the balloon is aspirated and the balloon is removed. From the bilateral trocar, a toothpaste-shaped bone cement in the mass phase is injected into the vertebral body. The working cannula is withdrawn after bilateral injection is completed. Generally, the amount of bone cement injected into a single vertebral body is about 6 ml. 7. Complications and prevention 1. Transient fever: Rarely seen, mostly due to inflammatory reaction caused by heat production of cement polymerization. Treatment with non-steroidal anti-inflammatory drugs; 2. Spinal cord and nerve root compression and thermal injury caused by bone cement leakage: Intraoperative strengthening of fluoroscopy and injection of bone cement dough can be avoided, and once it occurs, it should be removed by emergency surgery; 3. Spinal infection: Since high fever is generated when bone cement monomer and powder are polymerized, the chance of spinal infection is rare. The small, transient complication caused by PVP is 1%-3% in osteoporotic patients and up to 1% in patients with vertebral tumors. Severe, permanent complications are rare. 5. Hematoma with local bleeding: Most often seen in patients with multiple punctures or with bleeding and coagulopathy. Pay attention to the correction of coagulation function before surgery; 6. Rib fracture: mostly seen in patients with severe osteoporosis. It may be the result of thoracic extrusion during puncture; 7. Death: the cause of death is not clear, but it cannot be excluded that it is caused by pulmonary embolism due to simultaneous treatment of multiple vertebrae. It is recommended that PVP should not exceed 3 stages at a time.