1. Patient selection: Our personal experience involves pain relief and vertebral strengthening. The vast majority of patients treated were osteoporotic compression fractures (61.3%), and a small percentage were bone tumors (38.7%), and recent studies have shown that PKP is not only effective in relieving pain, but also in restoring vertebral height. Among the patient selection criteria, concordance between clinical assessment (pain site) and imaging (structural changes) is the most important indicator. Especially noteworthy was that the patient’s bone marrow edema signal with the pain site suggested evidence of the latest spinal involvement, and was therefore considered an indication for PKP surgery, while questionnaires were administered before and after PKP. 2. One-time construction of working channel: The junction of lumbar supraspinal articular process and transverse process or thoracic transverse process intercostal space as the entry point of puncture, the bony anatomical signs are more obvious, under minimally invasive conditions, the surgical field of the entry point can not be completely exposed, but by touching these bony signs, to determine the entry point is completely possible. Finger guidance is used to determine the needle point by touching the anatomical landmarks of the needle point. Because of the conventional imaging system guidance (CT and C-arm), image drift often occurs in practice, resulting in displacement of the puncture projection point. Meanwhile, because the puncture point is often in the bone crest, bone suture, or bone migration site, which often results in slippage of the tip of the puncture needle, it is not possible to accurately and quickly locate the point of needle insertion in a blinded view. The quickest way to find the exact puncture point and to be able to insert the needle quickly is to make a tiny incision guided by the projected point on the skin, touch the puncture point with the finger and perform the puncture. All patients are guided by CT + C-arm + finger guidance, which is more accurate and safe than operating under CT or C-arm alone, and faster than CT combined with a C-arm machine.CT combined with C-arm fluoroscopy is very safe and effective in percutaneous puncture technique. Especially for those vertebrae with anatomical variations, CT combined with C-arm fluoroscopy allows for an optimal puncture pathway. Of course, even if the optimal puncture angle and pathway are designed on the computer, the fact is that during the actual puncture process, the puncture point is not flat because the entry point is on the crest of the bone (lumbar herringbone crest) or at the gap between the two bones (junction of thoracic vertebrae ribs and transverse process), which is difficult to grasp by purely blind puncture, and it is necessary to repeat the puncture several times and confirm it several times by the imaging equipment, which prolongs the surgical time and increases the risk of various complications. Using the grid and infrared light of CT to mark the vertical projection of the skin at the optimal entry point, cut the skin 1.5cm transversely along this entry point, cut the deep fascia transversely, separate the lumbar dorsal muscles longitudinally and bluntly with straight vascular forceps, and the fingertips touch the entry point, at this point, guide the puncture, which can be completed in one go, and utilize the beveled opening of the puncture and the angle of the micro downward adjustments, to achieve the ideal pathway of the puncture. It reduces the puncture time, surgical risks and complications associated with puncture. Because of the use of a grid and infrared light from CT to mark the vertical projection of the skin at the optimal point of entry, the skin incision only needs to be able to insert a finger, and the increase in skin incision is not significant for a simple blind puncture, while lateral incision of the skin and the deep fascia reduces the obstruction of soft tissues when the puncture is tilted outward. In all cases, a unilateral approach was used, which is less invasive than a bilateral approach, and for the lumbar spine, the pedicle approach was preferred, whereas for the thoracic spine, the paraspinal approach was used. 3.Central filling of bone cement: the accuracy of puncture is improved, further change the way of treatment, using unilateral, large angle puncture, in order to solve the shortcomings of bilateral puncture of the vertebral body central bone spacer formation and reduce the complications, reduce trauma. Research on vertebroplasty bone water filling has been carried out for a long time both at home and abroad, and some results have been achieved. However, so far, these studies have been aimed at puncture accuracy and puncture safety, focusing on the safe filling of bone cement, and have not been able to put forward higher requirements for the bone cement filling site. Therefore, these research results are somewhat limited in clinical application. Vertebral body compression fracture often shows a wedge-shaped change, and the anterior middle third of the vertebral body is compressed, so cement filling in the anterior middle third of the vertebral body can provide mechanical characteristics more in line with its pathology and physiology, and cement filling in the central part can reduce bone water leakage because of a longer spatial distance from the surrounding important tissues and more tissue spacing, which can better ensure the safety of cement filling and provide better mechanical support than bilateral puncture. It can better ensure the safety of bone cement filling and provide better mechanical support, which is of greater research value and application prospect than bilateral puncture vertebral body lateral filling of bone cement. Our finger + CT + C-arm guidance can provide accurate puncture guarantee. 4. Cement leakage: The injection of bone cement is a most important process, which requires real-time monitoring by C-arm fluoroscopy or CT fluoroscopy in order to check the distribution of the cement in a timely manner and to clarify whether there is any leakage of bone cement. Therefore, CT fluoroscopy accelerates the assessment of cement distribution and allows earlier and more timely monitoring of cement leakage in any direction than C-arm fluoroscopic guidance alone. As a result, recent studies of CT-guided vertebroplasty have reported a higher incidence of small, asymptomatic cement leaks than conventional postoperative radiographic evaluation. Complications are rare if the patient is properly selected and the procedure is performed with care. However, the complication rate was significantly higher in metastatic tumors than in osteoporotic patients. Our study shows that CT guidance helps to minimize the occurrence of mild and severe complications. For example, spinal cord and nerve root compression due to epidural leakage of bone cement, pulmonary embolism due to venous leakage, nail channel hematoma formation, rib or arch root fracture, and pneumothorax. There were 2 cases of nailing hematoma, which may be related to the poor coagulation function of the patient’s age, and due to the fact that we used a tiny incision during the operation and did not use drainage after the operation. Strict asepsis combined with prophylactic use of antibiotics can be effective in avoiding infections. This study shows that there was no case of direct injury due to puncture and consequent indirect injury due to cement leakage from a ruptured pedicle, which could have had more serious and catastrophic consequences (paralysis of the patient). Asymptomatic paravertebral cement leakage was observed in 22 cases (20.7%), and although intraoperative and postoperative CT scans were helpful in the detection of minor cement leakage, our data on cement leakage were still significantly smaller than that of previous reports, which may be related to the one-time construction of the working channel and the cemented vertebral body central filling that we used, which reduces the pinning of cement due to the gradual compression of the bone around the working channel by the one-time puncture Leakage of bone cement, and the eccentric vertebral body central filling of bone cement, which increases the tissue spacing and spatial distance from the surrounding vital organs, also reduces the leakage of bone cement, which can better ensure the safety of bone cement filling and can provide better mechanical support. In patients with osteoporosis, leakage from the intervertebral space is often caused by the formation of voids or cracks in the endplates, but this does not change their biomechanical characteristics or accelerate disc degeneration. Patients with metastatic tumors are more prone to cemented venous plexus and epidural leakage due to tumor neovascularization. Intravascular bone cement leakage in the anterior vertebral body often leaks along the anastomotic branches of the paravertebral venous plexus, and its eventual entry into the vena cava system can lead to the formation of pulmonary embolism. Posteriorly, cement leakage occurs in the epidural or paravertebral venous plexus, where cement accumulation can cause spinal cord and nerve root compression, resulting in appropriate symptoms. In conclusion, cement leakage outside the vertebral body rarely produces symptoms. If the monitor detects cement leakage during intraoperative injection of cement, the injection should be interrupted immediately so that the cement can harden within a few seconds. 5. Pain relief: Due to the polymerization of the bone cement and the resulting stabilization of the vertebral body, clinically, the vast majority of patients experience pain relief within 24h after surgery. Previous reports have shown that in patients with metastatic bone tumors, the degree of pain relief was only 75% ~ 82%, and osteoporotic compression fractures reported pain disappearance of 73% ~ 97%. After mixing cases of metastatic tumor with osteoporosis, the degree of pain relief in this study (98%) was similar to the clinically reported results. Based on recent studies reported, future studies need to clarify the long-term outcomes after PKP treatment, not only based on symptomatic relief and disease reoccurrence, but also in terms of the final fate of the injected bone cement. 6. In conclusion, the use of CT + C-arm + finger-guided PKP surgery allows for the selection of an ideal operating path, the construction of a working channel in a single operation, the improvement of the success rate of the operation, the reduction of the operating time, the increase of the accuracy and safety of the PKP operation and the reduction of the complications.