• Jian Li, JiSheng Lin, JunChuan Xu, Hai Meng, Nan Su, ZiHan Fan, JinJun Li, Yong Yang, Dong Li, BingQiang Wang, and Qi Fei.
• Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2017 Sep 1; 105: 20-26.

ObjectiveTo describe a new technique for the efficient use of preoperative planning based on preoperative computed tomography-based three-dimensional (3D) model design for percutaneous vertebroplasty (PVP) in a patient with osteoporotic vertebral compression fracture.MethodsA 76-year-old woman with acute osteoporotic vertebral compression fracture (L1 level) accepted a novel precise PVP. A 3D model of thoracolumbar vertebrae (T12-L2) based on preoperative computed tomography scanning data and a simulative PVP (via a bilateral transpedicular approach) were built in MIMICS (Materialise Interactive Medical Image Control System) software. With the help of 3 radiopaque markers located at the skin of the back and preoperative digital design by MIMICS, bilateral skin entry points, needles direction including abduction angle and head inclination angle, and needle insertion depth were established.ResultsDuring surgery, only 1 shot of fluoroscopy was required to confirm the skin entry points. The operation took only about 23 minutes and total patient exposure dose was 4.5 mSv. The intraoperative radiologic results showed that the cement distribution in the L1 vertebra was good without any puncture-related complications. The patient's visual analog scale score improved from 9 points preoperatively to 2 points postoperatively. The patient's preoperative Oswestry Disability Index score was 80 points, which improved to 57.8 points postoperatively.ConclusionsThe novel precise PVP based on preoperative 3D model design allows 1) visualization of the morphology of the fractured vertebral body, 2) increased precision of puncture with decreasing incidence of puncture-related complications and reduced radiation exposure, and 3) less operation time, decreasing the learning curve of beginners with limited experience.Copyright © 2017 Elsevier Inc. All rights reserved.

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