The study was funded by Beijing Natural Science Foundation-Haidian Original Innovation Joint Fund (L232054) and Capital Health Development Research Special Fund (NO.2024-2-2024).

The present study was approved by the Ethics Committee of Beijing Friendship Hospital Capital Medical University. This method will be introduced via a retrospective case study, utilizing only the preoperative prone-position computed tomography (CT) imaging data of the patient. The &#34;Nine-grid Area Division Method&#34; in assisted percutaneous vertebroplasty (PVP) offers a simpler and more effective approach compared to traditional methods, resulting in reduced surgical and radiation exposure times. Th...

Enhancing Pedicle Puncture Precision with 3D Modeling and a Nine-Grid Method

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	<li>Wenhao, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+percutaneous+kyphoplasty+with+high-viscosity+and+low-viscosity+bone+cement+for+treatment+of+osteoporotic+vertebral+compression+fractures:+a+retrospective+study.">A comparison of percutaneous kyphoplasty with high-viscosity and low-viscosity bone cement for treatment of osteoporotic vertebral compression fractures: a retrospective study.</a> Geriatr Orthop Surg Rehabil. 13, 21514593221119625 (2022).</li><li>Xuebiao, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CT+features+and+risk+factors+of+pulmonary+cement+embolism+after+vertebroplasty+or+kyphoplasty+in+patients+with+vertebral+compression+fracture:+a+retrospective+cohort+study.">CT features and risk factors of pulmonary cement embolism after vertebroplasty or kyphoplasty in patients with vertebral compression fracture: a retrospective cohort study.</a> Quant Imaging Med Surg. 13 (4), 2397-2407 (2023).</li><li>Liehua, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+study+on+the+puncture+method+of+extrapedicular+infiltration+anesthesia+applied+during+lumbar+percutaneous+vertebroplasty+or+percutaneous+kyphoplasty.">A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty.</a> Medicine (Baltimore). 98 (33), e16792 (2019).</li><li>Lo Bianco, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interventional+pain+procedures:+a+narrative+review+focusing+on+safety+and+complications.+PART+2+Interventional+procedures+for+back+pain.">Interventional pain procedures: a narrative review focusing on safety and complications. PART 2 Interventional procedures for back pain.</a> J Pain Res. 16, 761-772 (2023).</li><li>Jie, W., Qiang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Beware+of+Brucella+spondylitis+following+vertebroplasty:+an+unusual+case+of+osteoporotic+vertebral+compression+fracture.">Beware of Brucella spondylitis following vertebroplasty: an unusual case of osteoporotic vertebral compression fracture.</a> Infect Drug Resist. 15, 2565-2572 (2022).</li><li>Xinqiang, H., Yongzhen, Z., Zhu, W., Mengpeng, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Case+report:+Cement+entrapped+in+the+inferior+vena+cava+filter+after+pedicle+screw+augmentation.">Case report: Cement entrapped in the inferior vena cava filter after pedicle screw augmentation.</a> Front Cardiovasc Med. 9, 892025 (2022).</li><li>Saracen, A., Kotwica, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+percutaneous+vertebroplasty:+An+analysis+of+1100+procedures+performed+in+616+patients.">Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients.</a> Medicine (Baltimore). 95 (24), e3850 (2016).</li><li>Peilun, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+&amp;#34;three-dimensional-printed+individual+guide+template-assisted+percutaneous+vertebroplasty&amp;#34;+for+osteoporotic+vertebral+compression+fracture:+a+prospective,+controlled+study.">A novel &amp;#34;three-dimensional-printed individual guide template-assisted percutaneous vertebroplasty&amp;#34; for osteoporotic vertebral compression fracture: a prospective, controlled study.</a> J Orthop Surg Res. 16 (1), 326 (2021).</li><li>Jiashen, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+sarcopenia+and+sagittal+parameters+on+the+residual+back+pain+after+percutaneous+vertebroplasty+in+patients+with+osteoporotic+vertebral+compression+fracture.">Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture.</a> J Orthop Surg Res. 17 (1), 111 (2022).</li><li>Songfeng, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+percutaneous+vertebroplasty+for+the+relief+of+osteoblastic+spinal+metastasis+pain.">Efficacy of percutaneous vertebroplasty for the relief of osteoblastic spinal metastasis pain.</a> Exp Ther Med. 22 (1), 727 (2021).</li><li>Ruszat, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Photoselective+vaporization+of+the+prostate:+subgroup+analysis+of+men+with+refractory+urinary+retention.">Photoselective vaporization of the prostate: subgroup analysis of men with refractory urinary retention.</a> Eur Urol. 50 (5), 1040-1049 (2006).</li><li>Junchuan, X., Jisheng, L., Jian, L., Yong, Y., Qi, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=&amp;#34;Targeted+percutaneous+vertebroplasty&amp;#34;+versus+traditional+percutaneous+vertebroplasty+for+osteoporotic+vertebral+compression+fracture.">&amp;#34;Targeted percutaneous vertebroplasty&amp;#34; versus traditional percutaneous vertebroplasty for osteoporotic vertebral compression fracture.</a> Surg Innov. 26 (5), 551-559 (2019).</li></ol>

The authors have no conflict of interest regarding any drugs, materials, or devices described in this study.

Percutaneous vertebroplasty (PVP) has demonstrated favorable clinical efficacy in managing painful osteoporotic vertebral compression fractures (OVCF)9. The utilization of precise percutaneous pedicle puncture technology by surgeons plays a crucial role in determining the optimal insertion point, direction, and depth of the puncture needle, thereby significantly reducing the occurrence of complications10. Currently, C-arm X-ray machines are widely employed in the domestic a...

Osteoporotic vertebral compression fracture (OVCF) is the most prevalent type of fracture among osteoporotic fractures and poses a significant clinical concern in contemporary healthcare1. According to current guidelines, percutaneous vertebroplasty is recognized as one of the most efficacious minimally invasive treatment modalities for OVCF2. The predominant method for performing percutaneous vertebroplasty (PVP) involves the pedicle puncture approach, which encompasses three key parameters: the identification of the bone puncture entry point, puncture angle, and puncture depth. Of these parameters, the selection of the bone puncture entry point is considered the most crucial.
Currently, C-arm X-ray machines are widely employed in the domestic and international practice of traditional PVP surgery to facilitate the adjustment of the surgical path of the puncture needle. The crucial aspect lies in identifying the &#34;ideal bone puncture point,&#34; which is conventionally situated at the projection &#34;left 10 points, right 2 points&#34; of the pedicle in the lumbar spine (Figure 1A)3. Despite their experience, even seasoned surgeons may make mistakes when determining appropriate puncture points based solely on personal experience. This can lead to puncture-related complications such as cement leakage into surrounding tissues, nerve root injury, and intra-spinal hematoma4,5,6. Additionally, nearly half of patients experience local complications from traditional PVP, with 95% of these complications attributed to cement leakage into surrounding tissue or embolization of paravertebral veins7. Our preliminary research found that the actual PVP bone puncture points in the lumbar spine are not always located at the ideal pedicle projection &#34;left 10 points and right 2 points&#34;8. Some actual puncture points can also achieve satisfactory puncture results near the &#34;ideal bone puncture point,&#34; which does not affect surgical safety and accuracy.
Based on the above assumptions, we propose, for the first time, the concept of the &#34;ideal bone puncture region&#34; for PVP in the lumbar spine and divide the projection of the pedicle into a &#34;Nine-grid Area&#34;. The concept of the ideal bone puncture region pertains to specific anatomical regions where the puncture entry point can successfully and securely reach the puncture ideal endpoint through the pedicle.The term &#34;Nine-grid Area Division Method&#34; refers to a technique in the X-ray anteroposterior image whereby the longest and shortest diameters of the pedicle projection are divided into three equal parts, resulting in the division of the area into nine regions (Figure 1B). These regions are sequentially numbered from 1 to 9, progressing from the outermost to the innermost and from top to bottom. Using the X-ray projection of the lumbar pedicle as an anatomical marker, we establish the &#34;ideal bone puncture region&#34; for PVP through the &#34;Nine-grid Area Division Method&#34; instead of being confined to a single point. We use computer simulation to explore a safe puncture path during the puncture process.
Hence, we suggest the implementation of the &#34;Nine-grid Area Division Method&#34; as a potential method for enhancing the convenience, efficiency, and safety of auxiliary puncture techniques in PVP surgery, with the aim of enhancing procedural accuracy and minimizing puncture-related complications. It is important to note that this study presents a theoretical approach that requires validation through extensive research to ascertain its efficacy and safety.

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			<td>Computer tomography&#160;</td>
			<td>Company GE</td>
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			<td>Geomagic Wrap (3-D reverse engineering production software)</td>
			<td>Oqton software</td>
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			<td>Company GE</td>
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			<td>&#160;Materialise Interactive Medical Image Control System (medical imaging processing software)</td>
			<td>Materialise Company</td>
			<td></td>
			<td>software</td>
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			<td>Solidworks (3-D modeling design software)</td>
			<td>Dassault Syst&#232;mes&#160;-&#160;SolidWorks Corporation</td>
			<td></td>
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			<td>Spirit Level Plus</td>
			<td>IOS App store</td>
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			<td>Company Philips</td>
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nine-grid area division method: a new ideal bone puncture region for percutaneous vertebroplasty in lumbar spine 

Percutaneous vertebroplasty (PVP) is widely recognized as an efficacious intervention for alleviating low back pain resulting from osteoporotic vertebral compression fractures. The ideal bone puncture point is conventionally situated at the projection "left 10 points, right 2 points" of the pedicle in the lumbar spine. Determining the optimal bone puncture point represents a critical and complex challenge. The accuracy of percutaneous vertebroplasty (PVP) is primarily influenced by the proficiency of the operating surgeons and the utilization of multiple fluoroscopes during the conventional procedure. Incidences of puncture-related complications have been documented globally. In an effort to enhance the precision of the surgical technique and reduce the occurrence of puncture-related complications, our team applied the "Nine-grid Area Division Method" for PVP in the lumbar spine to modify the traditional procedure. There is potential to decrease the number of puncture times, the radiation exposure dosage, and the duration of surgical procedures.
This protocol introduces the definition of the "Nine-grid Area Division Method" and describes the process of modeling target vertebrae DICOM imaging data within medical imaging processing software, simulating operations within a 3-D model, refining the 3-D model using reverse engineering production software, reconstructing the vertebral engineering model within 3-D modeling design software, and utilizing surgical data to determine safe entry regions for pedicle projection. By employing this methodology, surgeons can effectively identify appropriate puncture points with precision and ease, thereby reducing the intricacies associated with puncturing and enhancing the overall accuracy of surgical procedures.

Author Spotlight: Improving Percutaneous Vertebroplasty Surgical Accuracy and Efficiency Through Advanced Puncture Techniques

Nine-Grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine 

Our research is about the puncture techniques in PVP surgery. We are trying to answer how to enhance procedure accuracy and minimize puncture related complications during PVP surgery. With MGC of new technologies, various puncture techniques are developing rapidly, such as navigation system redemption of creating guided template, and so-There's a learning curve for learning to use medical imaging software.Furthermore, larger scale studies are imperative to validate the reliability and the practicability of this founding. Employing this methodology, surgeons may decrease the dosage of intraoperative projection and minimize the duration of surgical procedures required for adjusting the bone entry point of the puncture needle, ultimately improving surgical efficiency and efficacy.

CT imaging and digital modeling were performed in the hospital. It took 30 min to build the 3-D model from the CT images, ~10 min to polish the 3-D model in 3-D reverse engineering production software, and 15 min to reconstruct the vertebral engineering model and confirm the safe entry regions of pedicle projection in 3-D modeling design software. The ideal bone puncture region includes regions 1, 4, and 7 on the left side in this case. The notion of the ideal bone puncture region refers...

Herein, we present a "Nine-grid Area Division Method" for percutaneous vertebroplasty. A patient with an L1 vertebral compression fracture was selected as a case study.

Percutaneous vertebroplasty (PVP) is widely recognized as an efficacious intervention for alleviating low back pain resulting from osteoporotic vertebral ...

nine-grid-area-division-method-new-ideal-bone-puncture-region-for

Research

JoVE Journal

Medicine

3D Model Reconstruction and Simulation of Vertebral Compression Fracture Using Medical Imaging Processing Software

To begin in a medical imaging processing software, click New Project to export the computed tomography images of horizontal and sagittal angles of the patient's body in DICOM format. Select the desired slices for reconstructing the compressed vertebrae. Utilize the threshold segmentation tool to adjust the threshold range for the target vertebrae within 125 to 3071 Hounsfield units to create a mask.Use the duplicate mask function to generate two separate masks, mask A and mask B.Next, use the mask edit feature to erase the target vertebrae from mask A.Subsequently with the Boolean operations tool, subtract mask A from mask B, forming a new mask, mask C.Activate the calculate three dimensional function to reconstruct the target vertebrae using mask C.Name this three dimensional model as L1.In the objects interface, right click on New, then choose Draw and select Cylinder. Set the cylinder dimensions the same as the puncture needle with a length of 12.5 millimeters and a radius of 1.25 millimeters. Adjust the positioning of the cylinder using the move and rotate functions to achieve the ideal position.Throughout the simulation, the puncture needle must traverse the pedicle, preferably in its superior half with optimal tip positioning within the anterior one third of the vertebral body in the lateral view. Now right click on L1 in the objects interface and choose Export STL to export the file in STL format. Click Import to import the exported vertebral body solid file into the software.Employ the mesh doctor feature to eliminate distortions and spikes from the model. Thoroughly examine the rough model for any internal voids as the grid doctor function may mistakenly identify normal anatomical structures as distortions or spikes. Fill the structures appropriately.Employ the precise surface function to transform the solid model into a triangular mesh surface, selecting the organic geometry material. Wait for the automated surface construction process to complete and export the file in STP format.

Reconstruction of Vertebral Engineering Model and Pedicle Projection Analysis in 3D Modeling Design Software

After establishing the three-dimensional model from computed tomography images, click Open to import the STP format of the precise surface document into three-dimensional modeling design software. Employ the Section View feature to examine the pedicles morphology in horizontal, sagittal, and coronal orientations. In the section view panel, adjust the angle of the section for optimal visualization.Use Transparency Section Bodies to observe the narrowest point of the pedicles and record the angle parameters at Section 1 in the left panel. Adjust the angle of the vertebral model by clicking on the insert, features, move and copy function, and selecting the translate and rotate button. Return to the section view panel and adjust the view angle parameter in section one to zero.Fine tune the displacement parameters in the section one panel to obtain a satisfactory pedicle section view. Reorient for an improved perspective to observe the pedicle section. Document the confirmed displacement parameters in the panel.Use the move and copy function to manipulate the vertebral models position. Specify the displacement parameter in the left panel. Using the corner rectangle tool, encompass the entirety of the vertebral body.Next, navigate to features, reference geometry plane, and designate the section view as the first reference. Modify the offset distance parameter to relocate the newly created plane to the anterior third of the vertebral body. Create a sketch on this plane and draw a point at the midpoint of the vertebral body signifying the termination point of the puncture.Use the extruded cut function to cut the model. Designate the rectangular sketch generated as the selected contours. Adjust both the direction and depth to divide the vertebral body model into the vertebral body half and the lamini half.Save the engineering files in S-L-D-P-R-T format. Open the file containing the vertebral body part. Then create a sketch based on the section plane.Use the convert entity's function to convert the left pedicle projection into a curve sketch. Repeat the same for the right pedicle projection to acquire another curve sketch. Using the filled surface function, transform the curve sketches into surfaces with the left and right pedicle projection curve sketches serving as the boundary.After concealing the vertebra, display the resulting surface. In the features panel. Select the lofted boss or base function.Using the superior positioning of the left pedicle surface, designate the puncture endpoint as profiles to create a conical structure. Delineating the paths for pedicle puncture. Next, use the scale function to magnify the bilateral conical structure.Setting the centroid as the scaling center point and applying a scale factor of two. Use the move and copy body function to individually relocate the conical structures. In the mate setting panel, select the apex of the structure and the puncture endpoint with the matching mode set as coincident.Eliminate the vertebral body using the delete or keep body function. Save the biconical structure which compiles the bilateral pedicle puncture paths in S-L-D-P-R-T format. Use the insert part function to reassemble the lamini part and vertebral body part with the pedicle puncture set.Press okay to automatically align the insert position with the origin. Employ the combined body function to execute Boolean operations on the components. Subtract the puncture set from one half of the lamini while retaining all lamini components.Highlight that the ideal bone puncture regions include regions one, four and seven on the left side.

104 Views.  Capital Medical University.  Herein, we present a "Nine-grid Area Division Method" for percutaneous vertebroplasty. A patient with an L1 vertebral compression fracture was selected as a case study.

Enhancing Pedicle Puncture Precision with 3D Modeling and a Nine-Grid Method

Summary