The aim of this retrospective study was to evaluate a percutaneous pediculoplasty (PP) technique, using 3-dimensional C-arm CT reformation combined with fluoroscopic guidance for patients presented vertebral body metastasis with lytic pedicle. Thirteen patients (average age 57.8 years) were treated through lytic pedicle approach in our study. Subjective good and partial pain relief was reported with Visual Analogue Scale reduction ≥ 4 in 11/13 patients at 1 month after procedure, two patients with insufficient pain relief died from clinical complications unrelated with PP at 3 month follow-up. Pain relief was maintained in 10 patients at 6 month post-procedural follow-up. One patient died from underlying disease unrelated with the procedure at 5 month follow-up. PP through the lytic pedicle approach under 3-dimensional C-arm CT reformation combined with fluoroscopic guidance was a feasible, safe, and minimally invasive procedure that could provide both the precise control of needle placement and cement injection with one imaging system.