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Purpose:Percutaneous vertebroplasty (PVP) has been widely applied in the treatment of osteoporotic compression fractures, vertebral metastasis, multiple myeloma, and invasive hemangioma. With rare procedure-related complications, this procedure has been shown to achieve excellent pain relief and rapid fracture stabilization in vertebral diseases. However, percutaneous access to the upper thoracic vertebrae under regular fluoroscopic guidance during PVP is challenging, especially for severe compression fractures. The purpose of this study was to investigate the clinical feasibility and efficacy of PVP performed under the threedimensional C-arm computed tomography-guidance for the treatment of severe upper thoracic compression fractures.