Objective:To assess the feasibility of cone-beam computed tomography (CBCT) in achieving unipedicular access during spinal cement augmentation.Methods:A retrospective review of all patients who underwent CBCT-guided unipedicular spinal augmentation procedures between 1st January 2012 and 15th June 2015 was performed. Fifty-nine patients (43 women 16 men; mean-age, 74.0 years; range, 52-90 years) underwent unipedicular spinal augmentation in 78 vertebral levels (T5-T9 n=14, T10-L2 n=42, L3-L5 n=22). Degree of crossover in contralateral hemi-vertebral body, complications and 30-day mortality were recorded.Results:Ninety-seven percent (76/78) of procedures were technically successful. Two procedures failed due to vertebral sclerosis; For vertebroplasty, all cases (6/6) demonstrated crossover filling of cement, and 50% (3/6) showed cement crossover >50% of contralateral half. For kyphoplasty, 13 out of 15 demonstrated balloon and cement crossover >50% of contralateral half. Two kyphoplasty procedures required...