Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type II odontoid fractures



The objective of the study was to compare the safety, efficacy, and accuracy of the pedicle screws with the three-dimensional (3D) printed navigation template to the free-hand screws for type II odontoid fractures.

Patients and methods

A total of 60 patients with type II odontoid fractures, treated with either template guiding pedicle screws or free-hand screws, were retrospectively assessed. The guiding group was treated with pedicle screws with the assistance of a virtual reality (VR) software-designed, 3D printed navigation template with two guide tubes. The safety rate and treatment efficacy of the screw placement, as well as the trajectory accuracy, were evaluated by respective measures and compared between two surgical groups.


There were reduced surgical time (P < 0.05), blood loss (P < 0.01), and C-arm shots (P < 0.01) with 3D printed template guiding screws. The rates of safe pedicle screws in both C1 and C2 were significantly higher in 3D guiding group (P < 0.01) compared to the free-hand group, and the scores of visual analogue scale (VAS) and impairment scale (ASIA) were improved in guiding group at 1 week post-surgery (P < 0.01 and P < 0.05, respectively). Postoperative CT and image reconstruction showed the 3D guiding group had better horizontal screw accuracy on both sides of C1 (L: P < 0.001, R: P < 0.01) and C2 (L: P < 0.001, R: P < 0.01) than free-hand group.


The herein screw technique using 3D printed navigation template leads to greater improvement in the screw safety, efficacy, and accuracy, which may be a promising alternative to free-hand surgery for the treatment of odontoid fractures.

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Funding was provided by National Natural Science Foundation (Grant No. 81772367) and Major Military Science Research (Grant No. AWS17J004).

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Correspondence to Yongqing Xu.

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Li, Y., Lin, J., Wang, Y. et al. Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type II odontoid fractures. Eur Spine J (2020).

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  • Odontoid fractures
  • Atlantoaxial pedicle screw
  • Navigation template
  • Virtual reality
  • 3D printing