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Telemedicine services involve transmission of patient data over open computer network, and thus confront serious security challenges when the consequences are a matter of life and death. In this paper, we introduce an image-based simulated system for kyphoplasty telesurgery, wherein special attention is given to the fine-grained security implementation issues. Various security requirements are formalized and corresponding solutions are presented. Consequently, we implement the system to work in a secure way, while taking efficiency as a premier consideration.