Nine-Grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine
August 9th, 2024
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.
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 emergence of new technologies, various puncture techniques are developing rapidly, such as navigation system creating guided template and so on.
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 finding. By 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.
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 vertebra. Utilize the threshold segmentation tool to adjust the threshold range for the target vertebra 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 vertebra 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 vertebra 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 1/3 of the vertebral body in the lateral view. Now, right click on L1 in the object's interface and choose Export STL to export the file in STL format. Click Import to import the exported vertebra 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. 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 one 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 model's 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 lamina half. Save the engineering files in SLDPRT 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 SLDPRT format. Use the insert part function to reassemble the lamina 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 laminate while retaining all laminate components.
Highlight that the ideal bone puncture regions include regions one, four and seven on the left side.
Overview
This study introduces the "Nine-grid Area Division Method" for percutaneous vertebroplasty (PVP), focusing on enhancing procedure accuracy and minimizing complications. A case study involving a patient with an L1 vertebral compression fracture is presented.
Key Study Components
Area of Science
- Neurosurgery
- Percutaneous vertebroplasty
- Medical imaging techniques
Background
- Puncture techniques in PVP surgery are critical for successful outcomes.
- New technologies are rapidly evolving to improve surgical precision.
- There is a significant learning curve associated with medical imaging software.
- Larger studies are needed to validate findings in clinical practice.
Purpose of Study
- To enhance the accuracy of puncture techniques in PVP surgery.
- To minimize complications related to puncture procedures.
- To improve surgical efficiency and efficacy.
Methods Used
- Introduction of the Nine-grid Area Division Method.
- Utilization of navigation systems for guided templates.
- Assessment of intraoperative projection dosage.
- Evaluation of surgical procedure duration for needle entry point adjustments.
Main Results
- Improved accuracy in puncture techniques was observed.
- Reduction in intraoperative projection dosage was achieved.
- Decreased duration of surgical procedures was noted.
- Enhanced overall surgical efficiency and efficacy were reported.
Conclusions
- The Nine-grid Area Division Method shows promise in PVP surgery.
- Further validation through larger studies is necessary.
- Adoption of new technologies can significantly improve surgical outcomes.
Frequently Asked Questions
Executive Industry Relevance
Accurate localization of bone puncture regions in percutaneous vertebroplasty (PVP) is critical for minimizing procedural complications and optimizing surgical outcomes. The Nine-grid Area Division Method leverages advanced imaging and 3D modeling to standardize puncture site selection, reducing operator variability and radiation exposure. This approach supports higher predictive confidence and operational efficiency at key inflection points in device-enabled musculoskeletal interventions.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables precise anatomical modeling for hypothesis-driven device development.
- Supports functional validation of puncture pathways using quantitative imaging data.
- Facilitates mechanistic de-risking by clarifying safe entry zones in vertebral procedures.
Screening & Assay Development
- Standardizes anatomical segmentation for reproducible simulation of device trajectories.
- Provides quantitative outputs for evaluating puncture accuracy and safety margins.
- Enables scalable virtual screening of puncture strategies across vertebral models.
Translational & Preclinical Research
- Aligns 3D anatomical modeling with translational device testing in preclinical systems.
- Supports continuity from virtual simulation to cadaveric or animal model validation.
- Reduces procedural ambiguity, informing risk-adjusted advancement of device concepts.
Pipeline & Workflow Integration
The Nine-grid Area Division Method integrates into the device discovery continuum from anatomical modeling through preclinical validation, supporting iterative refinement and cross-team standardization.
- Discovery Biology: Clarifies vertebral entry zones, supporting hypothesis testing for device safety and efficacy.
- Screening: Delivers reproducible, quantitative segmentation for evaluating puncture site selection.
- Analytics: Provides measurable outputs on puncture accuracy, radiation exposure, and procedural duration.
- Translational Research: Bridges virtual modeling with preclinical device testing for robust validation.
- Enterprise Reuse: Establishes a reusable workflow for anatomical segmentation and device trajectory planning.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in device-enabled interventions.
- Operational Value: Enhances standardization, reproducibility, and procedural efficiency.
- Strategic Value: Supports better go/no-go decisions and reduces late-stage procedural risk.
- Portfolio Impact: Enables risk-adjusted prioritization of device concepts and procedural innovations.
Implementation Considerations
- Requires expertise in medical imaging processing and 3D modeling software.
- Demands access to DICOM imaging data and compatible analytical infrastructure.
- Necessitates cross-team agreement on segmentation and modeling standards.
- Adaptation may be needed for different vertebral levels or patient anatomies.
- Validation in larger, diverse datasets is essential for broader adoption.
