Spinal canal narrowing as a result of retropulsion of spinal structures before or during cement augmentation has been considered a contraindication to therapy. The authors describe three cases of compression fractures safely treated with cement augmentation with the novel application of C-arm cone-beam computed tomography (CT). All cases involved small amounts of posterior cement extrusion, after which osteotomy needles were left in place during C-arm cone-beam CT. Rapidly reformatted images were viewed with the use of bone windows, yielding three-dimensional visualization of pertinent anatomy to confirm endpoints of posterior extrusion and adequate bone filling.