ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNew Perspectives and Innovative Techniques in Contemporary Spine Surgery - Volume IIView all 17 articles
Enhancing C2 Pedicle Screw Placement in Hangman's Fractures: A Comparative Study of Navigation and 3D Printed Guidance Techniques
Provisionally accepted
- 1Chongqing University Fuling Hospital, Chongqing, China
- 2Sichuan GEM Flower Hospital, Chengdu, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Objective: This retrospective study aimed to analyze the accuracy and safety of pedicle screw placement in upper cervical spine surgery for Hangman's fractures, particularly in cases with high-riding vertebral artery (HRVA) at C2, using navigation technology and 3D-printed patient-specific templates. Methods: We included 33 patients with Hangman's fractures who underwent posterior cervical fixation with bone graft fusion or non-bone graft fusion surgery between January 2013 and January 2023. Patients were divided into two groups based on the intraoperative pedicle screw placement method: Group A (n=15) utilized a navigation system, and Group B (n=18) used a 3D printed navigation template. Clinical and radiological data were collected and compared. Results: One hundred and forty-four screws (66 navigated, 78 3D-printed templates) were inserted without vertebral artery, spinal cord, or nerve injury. Operative time per screw: Group A 24.0±5.6 min vs Group B 18.7±4.1 min; mean difference 5.3 min (22% reduction; 95% CI -9.1 to -1.5; P=0.018). Intra-operative blood loss:152±29 mL vs 105±19 mL; mean difference 47 mL (95% CI -66 to -19; P=0.001). Overall accuracy (Grade 0+1) was 98.5% (65/66) vs 98.7% (77/78) (odds ratio 1.05; 95% CI 0.11-10.2; P=0.97). In the Type-III fracture subgroup (8 screws per group), templates achieved 100% accuracy vs 87.5% with navigation (P=0.032) and lower cortical penetration (12.5% vs 37.5%; P=0.008). Post-operative VAS and NDI improved comparably (all inter-group P>0.05). At 24-month follow-up, all fractures had healed; C2/3 fusion rates did not differ (facet fusion 100% vs 100%; inter-body fusion 39% vs 39%; P>0.99). Conclusion: The use of 3D-printed patient-specific templates in upper cervical spine surgery for Hangman's fractures, especially in the presence of HRVA, is effective and safe. It offers comparable accuracy to navigation-assisted surgery while reducing operative time and blood loss. This approach may be particularly beneficial in minimizing the risk of vertebral artery injury and optimizing surgical outcomes. Compared to navigation technology, it can effectively improve the accuracy of screw placement in extremely unstable fractures.
Keywords: C2 pedicle screw placement, Hangman's Fractures, navigation, 3D Printed Guidance Techniques, comparative study
Received: 07 Jul 2025; Accepted: 29 Oct 2025.
Copyright: © 2025 Rao, Li, Xiao, Liao, Wang and Shang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yi Li, liyil198@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.