Abstract: A bone cement delivery system for vertebroplasty with a cannula having a rigid metal tubular inner wall surrounding a central conduit with a distal outlet port, a rigid metal tubular outer wall extending around the inner wall to define a peripheral conduit with a distal inlet port in the form of fenestrations defined in the tubular outer wall, unobstructed and directly exposed to an environment of the delivery system, a proximal inlet port in communication with the central conduit and a proximal outlet port in communication with the peripheral conduit. A vacuum pump communicating with the proximal outlet port of the peripheral conduit applies a pressure in the range of 10 to 100 KPa to create a pressure gradient between the central conduit and the peripheral conduit to produce a difference in flow rate between the conduits guiding the displacement of bone fluid and the flow of cement.