The patient is made to lie on the operative table and given conscious sedation. Once the patient has been given sedation the patient is positioned on the stomach and with the chest and the sides supported by the pillows. Based on the section of the spine which needs to be addressed (lumbar, cervical or thoracic) where the compressed vertebra is housed at the back of the neck will be cleansed and prepared.
A local anesthetic is then injected in the region where a small half-inch incision is made in the ski right over the bone that is fractured. Through the pedicle screws, two large-diameter needles are inserted inside the vertebral body with the aid of fluoroscopy.
For the injection of the cannula into the posterior portion of the vertebral body (trans-or parapedicular), a bilateral procedure is typically followed. A monolateral strategy is followed in very rare situations. Biplanar fluoroscopy is used by reaming, balloon expansion and then cementing procedures to mount the instruments and control the entire process. Two functional channels are formed within the anterior part of the vertebral body with the aid of the remaining equipment and the necessary balloons are inserted afterward. These balloons are available in the size of 20 mm or maximal volume accommodating 4 to 6 ml respectively.
The balloons should be kept centrally between the endplates in the anterior two-thirds of the vertebral body ideally. After placement with the help of two radio-opaque markers, the position is checked. After insertion, they are inflated with the help of visual volume and the pressure built up can control the vertebra that is compressed and allows for the creation of a cavity. Under a lateral fluoroscopic control, the behavior of the vertebral body is monitored closely.
When the pressure is raised above 250 psi which is the compliance of the fractured VB or the gradient of the pressure increment allows important information about the potential of height restoration, the inflation is stopped.
When the balloon contacts the cortical surface of the VB or if the expansion happens to cross the border of the vertebral body and the height of the same gets restored, then the balloon is deflated gradually and withdrawn away and the cavity gets filled with polymethylmethacrylate or PMMA under continuous fluoroscopic control. Cement is applied with a nozzle filler with a plunger device and a stylet. The small diameter permits the build-up of enormous force and pressure which allows injecting the cement at very high viscosity.
Before the cement starts hardening, the needles are withdrawn promptly and the small skin incision gets closed with the help of strips. The remaining cement in the mixing bowl will be allowed to harden and thereafter patient will be allowed to move.