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

Summary

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.

Abstract

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.

Introduction

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....

Protocol

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 "Nine-grid Area Division Method" 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.......

Discussion

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.......

Materials

Name	Company	Catalog Number	Comments
Computer tomography	Company GE		machine
Geomagic Wrap (3-D reverse engineering production software)	Oqton software		software
Magnetic resonance image machine	Company GE		machine
Materialise Interactive Medical Image Control System (medical imaging processing software)	Materialise Company		software
Solidworks (3-D modeling design software)	Dassault Systèmes - SolidWorks Corporation		software
Spirit Level Plus	IOS App store		gradientor
X-ray machine	Company Philips		machine