An elongated shaft is sized and configured to establish an access path to bone having an interior volume occupied, at least in part, by cancellous bone. The elongated shaft includes a distal end portion having a side opening. A first tool is sized and configured to be carried by the shaft and includes a region that is capable of being controllably advanced by a user through the side opening to project outside the distal end portion and contact cancellous bone. Contact between the region and cancellous bone can modify cancellous bone for introduction of bone filling material, e.g., by creating at least one flow path for the bone filling material.