A tamping apparatus is described that includes a cannula that has a tubular wall that includes a distal end portion that defines a tamping face. The cannula defines a longitudinally aligned aperture or lumen that provides access for an insert and the injection of treatment materials such as a bone graft. The distal end portion of the cannula can also include a plurality of movable elements that can be a part of or connected to the tubular wall. The tamp apparatus can also include a cannula or stylet that can be moved within aperture of cannula and is employed to move elements between the first position and second position of tamp apparatus.