OBJECTIVE: To explore the feasibility of C-arm navigation-guided puncture for Kyphon balloon-expanded vertebroplasty. METHODS: Eight fresh osteoporotic spinal compression fractures underwent Kyphon balloon-expanded vertebroplasty under C-arm navigation from October 2005 to March 2006. The fracture-adjacent spinous process was selected as a reference during the procedure, and the C-arm X-ray fluoroscopy was used to view the spine in the frontal and lateral positions, and the vertebral puncture was performed and the passage required for Kyphon balloon-expanded vertebroplasty was completed by navigation simulation images. In addition, the number of X-ray exposures was compared in six cases that had recently been operated more skillfully with Kyphon balloon-expanded vertebroplasty under conventional C-arm fluoroscopy. RESULTS: Subnavigation puncture required 8 to 16 additional x-ray fluoroscopies, with a mean of 11.4. The six cases under conventional C-arm fluoroscopy for Kyphon balloon-expandable vertebroplasty had 18 to 28 X-ray exposures, with an average of 22.5. The difference in the number of fluoroscopic views required between the two methods was approximately twofold. x-ray fluoroscopy after C-arm guided puncture in eight patients confirmed that the puncture was within the expected requirements. CONCLUSION: C-arm guided Kyphon balloon-expandable vertebroplasty does have the advantage of significantly fewer X-rays and accurate punctures compared to conventional Kyphon balloon-expandable vertebroplasty. The disadvantage is that an additional small incision is required to expose the spinous process to fix the navigation reference frame. Kyphon balloon-expandable vertebroplasty does provide very encouraging results in the treatment of osteoporotic compression fractures, both in terms of correcting spinal deformities and in terms of pain relief. Although the procedure is minimally invasive, there are certain drawbacks, such as the high number of X-ray fluoroscopies during the procedure and the accumulation of radiation doses that may be harmful to both the patient and the operator; in addition, puncture requires accurate localization. Navigation-guided puncture can effectively solve the above problems. Our hospital has carried out 8 cases of this procedure, and we summarize our experience as follows. Clinical data 1. General data 41 cases of vertebroplasty for spinal compression fractures were performed since March 2003. 8 cases of vertebroplasty under C-arm navigation were performed from October 2005 to March 2006, 3 men and 5 women. Age: 61-78 years old, mean: 66.3 years old. Duration of fracture at the time of surgery: 5 days to 35 days. Mean: 10.2 days. Compression about 1/3: 3 cases, compression about 1/2: 2 cases, compression about 2/3: 3 cases. History of definite fall injury: 6 cases, no definite trauma history: 2 cases. In addition, the number of X-ray irradiation was compared with that of the 6 cases in which Kyphon balloon expansion vertebroplasty under conventional C-arm fluoroscopy had been operated more skillfully recently. 2.Surgical method After tracheal intubation and stabilization of general anesthesia, the patient was placed in prone position. A round pillow was placed on each of the thoracic and pelvic regions to hyperextend the thoracolumbar segment to facilitate vertebral body repositioning. The spinous process of the segment adjacent to the fracture is selected, and the skin is cut approximately 1.5 cm long to reveal the supraspinous ligament, and the spinous process is revealed by peeling the soft tissue on both sides with a small bone knife. A navigation reference frame was fixed and a navigation system (Stethstation, Medtronic, U.S.A.) and a C-arm X-ray machine were connected. A front and side X-ray image centered on the compressed vertebral body is taken, and the navigation system acquires the image and registers it. Guided by the calibrated navigated orthopantomogram, the position of the arch root on the side of the compressed vertebral body on the orthopantomogram was first determined on the skin, and then moved horizontally outward 1 cm for the incision position. The skin is incised longitudinally subcutaneously for approximately 0.5 cm, and a percutaneous puncture needle with a sleeve is inserted percutaneously at a certain angle and measured depth in the direction of the vertebral arch root under navigation guidance, and the sleeve is fixed to the vertebral arch root bone cortex. After repeatedly observing the angle and expected depth of the puncture needle on the navigated virtual frontal and lateral images and determining that there is no error, the puncture needle is drilled through the bone cortex along the direction of the vertebral arch root pointing anteriorly and inferiorly, then the sleeve outside the puncture needle is fixed at the puncture point, the puncture needle is removed and replaced with a chisel, and the angle and direction of needle entry is determined again under navigation guidance to ensure that the chisel is completely within the vertebral arch root. The gouge is slowly rotated and the bony tunnel drilled through the pedicle inward and downward to a position 3 mm from the anterior edge of the vertebral body in the lateral phase. The sleeve is fixed at the puncture point, the gouge is removed, a fine guide pin is inserted, and the working sleeve is removed. The Kyphon-specific working sleeve is inserted through the fine guide pin into the vertebral arch, with the tip of the working sleeve inserted through the arch in the lateral phase just above the posterior edge of the vertebral body by approximately 2 mm under C-arm fluoroscopy. The tip is located beyond the medial edge of the arch in the orthopantomogram. The fine guide needle is removed and the channel is widened again with a Kyphon balloon drill and lighter at a predetermined length through the working sleeve and the walls are smoothed. The above procedure is repeated to complete the contralateral pedicle puncture. The subsequent balloon placement and gradual expansion process is the same as that of conventional Kyphon balloon expansion vertebroplasty under X-ray fluoroscopy. 3. Postoperative treatment The next day after the operation, the patient wore a brace to move on the ground and applied anti-osteoporosis drugs to supplement the treatment. Results X-ray fluoroscopy after C-arm navigational puncture confirmed that the puncture was within the expected requirements in all eight patients. X-ray fluoroscopy was required 8 to 16 times after navigational puncture, with a mean of 11.4 times. The six cases under conventional C-arm fluoroscopy with Kyphon balloon dilatation vertebroplasty went into X-ray fluoroscopy 18 to 28 times, with an average of 22.5 times. The difference in the number of fluoroscopies required between the two methods was approximately 2-fold in relation to each other. Discussion 1. Intraoperative X-ray irradiation time and frequency Traditional Kyphon balloon-expandable vertebroplasty requires repeated fluoroscopy of the C-arm during localization of the pedicle and puncture to ensure the accuracy of the puncture. The use of navigation-guided positioning puncture requires only one frontal and lateral radiograph to form the navigation simulation image, which greatly reduces the number of x-ray exposures and exposure time during positioning puncture and reduces the risk of high radiation exposure to the patient and operator. At present, X-ray radiation is attracting more and more attention, and there are reports of studies on the hazards of intraoperative fluoroscopy on the skin, cornea, thyroid and gonads. 2. Puncture accuracy Traditional Kyphon balloon dilatation vertebroplasty can only obtain one plan view during localization of the pedicle and puncture due to C-arm fluoroscopy in one operation, and the procedure is often interrupted to adjust the puncture point and needle direction. Repeated fluoroscopy leads to a decrease in puncture accuracy, and repeated punctures increase the error rate and the trauma and operative time of the procedure. In contrast, navigation-guided puncture can simultaneously obtain two planes of images similar to G-arm front and side, which increases the accuracy of puncture and reduces surgical errors. From another perspective, it has been shown that the accuracy of internal fixation of the pedicle nail under navigation is higher than that of traditional manipulation, and the Kyphon balloon-expanded vertebroplasty positioning puncture method is similar to that of internal fixation of the pedicle screw, so that the accuracy of puncture can be improved by navigated vertebroplasty. 3, postoperative imaging evaluation Postoperative X-ray frontal and lateral images of the eight cases showed satisfactory fracture repositioning, and the bone cement filling was satisfactory in all the other six cases except for one case of forward leakage and one case of leakage from the arch root puncture, and no complications occurred. Due to the small number of cases and short follow-up time, there was no calculation of the rate of vertebral body height reduction and loss. Minimally invasive technology is one of the key directions of surgical development, and minimally invasive is required not only for the surgical incision, but also for the patient and even for the operator during the whole treatment process. c-arm guided Kyphon balloon-expandable vertebroplasty does have the advantage of significantly reducing the number of x-ray exposures and accurate puncture compared to conventional Kyphon balloon-expandable vertebroplasty. The disadvantage is that an additional small incision is required to expose the spinous process to fix the navigation reference frame.