Objective To evaluate the safety and accuracy of 3D printed guide plate in pedicle screw implantation of upper cervical deformity.

Methods Preoperative CT data of 13 patients with upper cervical deformity in the Imaging Center of the Second Affiliated Hospital of Bengbu Medical College from January 2019 to January 2021 were selected, and individualized solid cervical spine models and guide plates of patients with upper cervical deformity were designed and printed in equal proportion. The experimental group received 3D printed guide plate assisted pedicle screw implantation and the control group received intraoperative fluoroscopic assisted positioning pedicle screw implantation by hand. Postoperative CT three-dimensional reconstruction was used to evaluate the safety and accuracy of screw implantation. According to whether lateral perforation occurred, the screws were divided into four categories: class Ⅰ (not perforated), class Ⅱ (≤2 mm) as safe placement, classⅢ (＞ 2 mm ~ ≤4 mm), class Ⅳ (＞ 4 mm) as unsafe placement.

Results The safety rates of screw implantation in the experimental group and the control group were 98.44% and 85.94%, respectively (P ＜ 0.05). The number of fluoroscopies for placement of a single screw (2.69 ± 0.61) was less than that of the control group (8.66 ± 0.72) (P ＜ 0.0), and the time taken (11.66 ± 1.17) min was shorter than that of the control group (23.19 ± 0.43) min (P ＜ 0.01).

Conclusion Compared with freehand screw placement, 3D printed guide plate is safe, more efficient and accurate for pedicle screw implantation in patients with upper cervical deformity, which breaks the original operational limitations and is worthy of clinical promotion.