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From a position in which the opponent is standing behind the wrestler, the wrestler underhooks his/her arms under the opponent's arms. Then the wrestler twists his / her body around so that the wrestler is facing the ground and the opponent is standing with his / her back resting against the wrestler's back. Then the wrestler stands while the opponent is in an upside down position while both the opponent and the wrestler's arms are still hooked and then the wrestler then drops to a sitting position. Another way to get the opponent into the position is to approach a standing opponent from behind, hook the opponent's arms, bend forward under the opponent, and then rise up, raising the opponent upside down.
This technique is extremely dangerous, as the receiver's arms are restrained and his / her head is not placed between the wrestler's legs, giving him / her little to post against. The wrestler receiving the technique is almost entirely dependent on the wrestler's strength and coordination to avoid serious neck injury.
Though the move is often referred to as a reverse gory special piledriver, or a back to back double underhook piledriver, it is best known in Japan as a Kudo Driver, a name in reference to the move's original inventor, Japanese female wrestler, Megumi Kudo, who actually called it the Kudome Valentine. "Sugar" Shane Helms popularized the name Vertebreaker, a reference to a character from the comic book Spawn, in America after using the move under that name in World Championship Wrestling.