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However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of <jats:italic>perfect<\/jats:italic> screw insertion (OR: 4.34, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.00001) and lowered the incidence of <jats:italic>moderate<\/jats:italic> (OR: 0.26, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.00001) and <jats:italic>poor<\/jats:italic> (OR: 0.09, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.00001), blood loss (MD: -83.82, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.00001), and fluoroscopy usage (MD: -3.47, <jats:italic>P\u2009&lt;\u2009<\/jats:italic>0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, <jats:italic>P\u2009=\u2009<\/jats:italic>0.07), or post-operative JOA (MD: 0.17, <jats:italic>P\u2009=\u2009<\/jats:italic>0.47), and VAS (MD: -0.09, <jats:italic>P\u2009=\u2009<\/jats:italic>0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.<\/jats:p>","DOI":"10.1007\/s12306-024-00879-1","type":"journal-article","created":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T13:50:06Z","timestamp":1736689806000},"page":"241-255","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["3D-printed drill guide versus fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5105-0903","authenticated-orcid":false,"given":"A.","family":"Al-Saadawi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0912-903X","authenticated-orcid":false,"given":"S.","family":"Tehranchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9055-969X","authenticated-orcid":false,"given":"R.","family":"Chekuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3500-2175","authenticated-orcid":false,"given":"A.","family":"Oehlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-4144","authenticated-orcid":false,"given":"F.","family":"Sedra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,12]]},"reference":[{"key":"879_CR1","unstructured":"Forbes J, Das JM. 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