Sphereplasty With 3D-Printed Porous Titanium Microspheres for Thoracolumbar Vertebral Compression Fractures: 2-Dimensional Operative Video

Conventional kyphoplasty for vertebral compression fractures (VCFs) relies on polymethylmethacrylate (PMMA), which may cause cement leakage, thermal necrosis, and increased vertebral rigidity.1-4 Sphereplasty is a novel vertebral body augmentation technique using 3-dimensional printed porous titanium microspheres (PTMs) conceived to restore vertebral height and promote biological bone integration.5,6 This video aims to demonstrate the operative steps and technical nuances of sphereplasty for VCF management. Through a standard bilateral transpedicular approach, Jamshidi needles are inserted into the vertebral body, followed by guidewire placement and drilling under fluoroscopic control while avoiding anterior wall penetration. Working cannulas are advanced and bilateral balloon catheters are inflated to restore vertebral height and create a cavity. PTMs are then delivered through preloaded cannulas to fill the cavity symmetrically. The microspheres adhere to each other through a “Velcro effect” generated by their trabecular surface, creating a compact structure that resists migration or extrusion. Their interconnected porosity provides an osteoconductive scaffold for cell adhesion and bone regeneration.6 The procedure allows direct control of implant positioning, height restoration, and vertebral stabilization without the risks associated with PMMA injection. The technique demonstrates promising biomechanical and biological outcomes. Sphereplasty with PTMs offers a safe, controllable, and biologically favorable alternative to PMMA-based kyphoplasty for VCFs, combining structural stability with osteogenic potential. Patient provided written informed consent both for surgery and publication of video and radiological images. Institutional Review Board/Ethics Committee approval was not required because this case does not involve any experimental procedure. The participants and any identifiable individuals consented to publication of his/her image. Images (A-D) in the video used with permission as follows at 04:58 © 2025, Roberto Drago. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_qsy8twud"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}