The invention relates to devices and methods for creating a curvilinear cavity within a vertebral body or other body structure. An example method of forming a void in bony structure includes accessing a bony structure with a cannula, inserting a distal end of a combined drill and reaming device through the cannula and into the bony structure, manipulating the distal end of the combined drill and reaming device to create a void in the bony structure, and removing the distal end of the combined drill and reaming device from the cannula.