3D-printed patient-specific guides improve screw accuracy in upper cervical spine surgery: a comparative study

To evaluate the feasibility and clinical efficacy of patient-specific 3D-printed guide plates for pedicle screw placement in the upper cervical spine, compared with the conventional free-hand technique.

A retrospective analysis was conducted on 39 patients who underwent upper cervical spine surgery between June 2009 and June 2022. Patients were divided into a guide plate group (n = 24) and a free-hand control group (n = 15). Surgical parameters (operative time, blood loss, fluoroscopy frequency), screw placement accuracy (assessed by Kawaguchi classification on postoperative CT), and clinical outcomes (VAS, JOA, and ASIA scores) were compared between groups.

A total of 141 pedicle screws were placed. The guide plate group achieved a significantly higher rate of perfect screw placement (81.8 vs. 62.3%, P = 0.009) and fewer grade 2 cortical breaches. Operative time, blood loss, and fluoroscopy exposure were significantly reduced in the guide plate group (all P < 0.05). Both groups showed significant postoperative improvements in all clinical scores (P < 0.05), with no significant intergroup differences at final follow-up.

Patient-specific 3D-printed guide plates significantly improve screw placement accuracy and reduce operative time, blood loss, and radiation exposure in upper cervical spine surgery, while achieving clinical outcomes comparable to the free-hand technique. This method is a safe and effective alternative for upper cervical pedicle screw fixation.