{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:19:04Z","timestamp":1788153544967,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010816","name":"Anhui Provincial Department of Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010816","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic>n<\/jats:italic>\n                      = 24) and a free-hand control group (\n                      <jats:italic>n<\/jats:italic>\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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009) and fewer grade 2 cortical breaches. Operative time, blood loss, and fluoroscopy exposure were significantly reduced in the guide plate group (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Both groups showed significant postoperative improvements in all clinical scores (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05), with no significant intergroup differences at final follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1853420","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:29:50Z","timestamp":1788150590000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["3D-printed patient-specific guides improve screw accuracy in upper cervical spine surgery: a comparative study"],"prefix":"10.3389","volume":"17","author":[{"given":"Guoqi","family":"Niu","sequence":"first","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalong","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Shandong First Medical University","place":["Tai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weili","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawei","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhong","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Shandong First Medical University","place":["Tai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1111\/os.13997","article-title":"Early outcomes of bone autografting in the bilateral atlantoaxial joints applied in posterior fusion surgery","volume":"16","author":"Wang","year":"2024","journal-title":"Orthop Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e34630","DOI":"10.7759\/cureus.34630","article-title":"Improvement of chronic neck pain after posterior atlantoaxial surgical fusion via multimodal chiropractic care: a case report","volume":"15","author":"Chu","year":"2023","journal-title":"Cureus."},{"key":"B3","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/00007632-200301010-00005","article-title":"Partial corpectomy for cervical spondylosis","volume":"28","author":"Groff","year":"2003","journal-title":"Spine (Phila Pa 1976)."},{"key":"B4","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3171\/2016.12.SPINE16803","article-title":"Paravertebral foramen screw fixation for posterior cervical spine fusion: biomechanical study and description of a novel technique","volume":"27","author":"Maki","year":"2017","journal-title":"J Neurosurg Spine."},{"key":"B5","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3171\/2018.1.SPINE17875","article-title":"Evaluation of C2 pedicle screw placement via the freehand technique by neurosurgical trainees","volume":"29","author":"Pham","year":"2018","journal-title":"J Neurosurg Spine."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e2054","DOI":"10.1002\/rcs.2054","article-title":"Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution","volume":"16","author":"Wallace","year":"2020","journal-title":"Int J Med Robot."},{"key":"B7","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.spinee.2019.10.012","article-title":"Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging","volume":"20","author":"M\u00fcller","year":"2020","journal-title":"Spine J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1186\/s13018-020-01798-0","article-title":"Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis","volume":"15","author":"Azimi","year":"2020","journal-title":"J Orthop Surg Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1055\/s-0036-1583942","article-title":"Differences between manufacturers of computed tomography-based computer-assisted surgery systems do exist: a systematic literature review","volume":"7","author":"Nooh","year":"2017","journal-title":"Global Spine J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1111\/os.13729","article-title":"Detection of common anatomical landmarks and vertical trajectories for freehand pedicle screw placement","volume":"15","author":"Wang","year":"2023","journal-title":"Orthop Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"E193","DOI":"10.1097\/BSD.0000000000000813","article-title":"Accuracy and safety in screw placement in the high cervical spine: retrospective analysis of O-arm-based navigation-assisted C1 lateral mass and C2 pedicle screws","volume":"32","author":"Hur","year":"2019","journal-title":"Clin Spine Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2243","DOI":"10.1002\/rcs.2243","article-title":"The development of computer-aided patient-specific template design software for 3D printing in cranio-maxillofacial surgery","volume":"17","author":"Memon","year":"2021","journal-title":"Int J Med Robot."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e87164","DOI":"10.7759\/cureus.87164","article-title":"Pediatric Craniovertebral junction anomalies: a literature review","volume":"17","author":"La","year":"2025","journal-title":"Cureus."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1089\/3dp.2022.0281","article-title":"Diverse Applications of three-dimensional printing in biomedical engineering: a review","volume":"10","author":"Agarwal","year":"2023","journal-title":"3D Print Addit Manuf."},{"key":"B15","doi-asserted-by":"publisher","first-page":"3948","DOI":"10.12659\/MSM.895597","article-title":"Clinical use of 3D printing guide plate in posterior lumbar pedicle screw fixation","volume":"21","author":"Chen","year":"2015","journal-title":"Med Sci Monit."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1097\/BRS.0b013e31825ab547","article-title":"Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide","volume":"37","author":"Kawaguchi","year":"2012","journal-title":"Spine (Phila Pa 1976)."},{"key":"B17","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.jos.2020.02.019","article-title":"The critical cutoff point of the Zurich claudication questionnaire and the Japanese orthopaedic association score indicating locomotive syndrome in patients with lumbar spinal canal stenosis","volume":"26","author":"Araki","year":"2021","journal-title":"J Orthop Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1186\/s13018-022-03254-7","article-title":"Does cervical curvature affect neurological outcome after incomplete spinal cord injury without radiographic abnormality (SCIWORA): 1-year follow-up","volume":"17","author":"Qi","year":"2022","journal-title":"J Orthop Surg Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13018-019-1525-y","article-title":"Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?","volume":"15","author":"Wenning","year":"2020","journal-title":"J Orthop Surg Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"434","DOI":"10.14245\/ns.2244034.017","article-title":"Impact of radiation therapy on outcomes after spinal instrumentation for craniocervical junction malignancies","volume":"19","author":"Muir","year":"2022","journal-title":"Neurospine."},{"key":"B21","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/BRS.0000000000001007","article-title":"An approach to primary tumors of the upper cervical spine with spondylectomy using a combined approach: our experience with 19 cases","volume":"43","author":"Wei","year":"2018","journal-title":"Spine (Phila Pa 1976)."},{"key":"B22","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/00002517-199407010-00003","article-title":"Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report","volume":"7","author":"Abumi","year":"1994","journal-title":"J Spinal Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2280","DOI":"10.1097\/01.brs.0000182275.31425.cd","article-title":"Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws","volume":"30","author":"Richter","year":"2005","journal-title":"Spine (Phila Pa 1976)."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1097\/00007632-200007010-00009","article-title":"Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques","volume":"25","author":"Ludwig","year":"2000","journal-title":"Spine (Phila Pa 1976)."},{"key":"B25","doi-asserted-by":"publisher","first-page":"171","DOI":"10.4184\/asj.2018.12.1.171","article-title":"A review of current clinical applications of three-dimensional printing in spine surgery","volume":"12","author":"Cho","year":"2018","journal-title":"Asian Spine J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.jor.2023.05.009","article-title":"Current applications of 3-dimensional printing in spine surgery","volume":"41","author":"Kabra","year":"2023","journal-title":"J Orthop."},{"key":"B27","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/j.spinee.2019.11.004","article-title":"Three-dimensional printing in spine surgery: a review of current applications","volume":"20","author":"Tong","year":"2020","journal-title":"Spine J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.spinee.2018.05.001","article-title":"Outcome and safety analysis of 3D-printed patient-specific pedicle screw jigs for complex spinal deformities: a comparative study","volume":"19","author":"Garg","year":"2019","journal-title":"Spine J."},{"key":"B29","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s11548-019-02110-0","article-title":"3D printing method for next-day acetabular fracture surgery using a surface filtering pipeline: feasibility and 1-year clinical results","volume":"15","author":"Weidert","year":"2020","journal-title":"Int J Comput Assist Radiol Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0171509","DOI":"10.1371\/journal.pone.0171509","article-title":"Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine","volume":"12","author":"Guo","year":"2017","journal-title":"PLoS One."},{"key":"B31","doi-asserted-by":"publisher","first-page":"932296","DOI":"10.3389\/fsurg.2022.932296","article-title":"Individualized 3D printed navigation template-assisted atlantoaxial pedicle screws vs. free-hand screws for the treatment of upper cervical fractures","volume":"9","author":"Niu","year":"2022","journal-title":"Front Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.jocn.2020.04.008","article-title":"3-Dimensional printing templates guiding versus free hand technique for cervical lateral mass screw fixation: a prospective study","volume":"78","author":"Feng","year":"2020","journal-title":"J Clin Neurosci."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1853420\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:29:51Z","timestamp":1788150591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1853420\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":32,"alternative-id":["10.3389\/fneur.2026.1853420"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1853420","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"1853420"}}