Comparison Between 3D-Printed Drill Guides and Freehand Surgery for Pedicle Screw Instrumentation in Children and Adolescents with Congenital Scoliosis: A Systematic Review and Meta-analysis.

Abstract

Congenital scoliosis (CS) is a spinal deformity with a heterogeneous presentation, significantly affecting spinal development if untreated. Pedicle screw instrumentation is a common surgical intervention for CS, but the freehand technique often leads to inaccuracies, increasing the risk of complications. Recently, 3D-printed drill guides have emerged as a cost-effective and accurate alternative to computer-assisted navigation systems. This study systematically reviewed and compared the effectiveness of 3D-printed drill guides and the freehand technique in pedicle screw placement for children with CS. A systematic search across five databases identified eligible studies comparing 3D-printed drill guides with freehand for pedicle screw instrumentation in CS patients. A total of three studies, involving 123 patients (60 in the 3D printing group and 63 in the freehand group), were included. Outcomes assessed included screw placement accuracy, complication rates, operation time, and surgical outcomes. Statistical analyses were conducted using a random-effects model in R software. 3D-printed drill guides demonstrated statistically significant improvements in screw placement accuracy (GR 0: OR 1.80, <i>p</i> = 0.015; GR 0 + 1: OR 3.69, <i>p</i> < 0.001) and reduced rates of severe screw misplacement (GR 3: OR 0.20, <i>p</i> = 0.019). Additionally, the 3D printing group experienced significantly fewer complications (OR 0.16, <i>p</i> = 0.02). No statistically significant differences were observed in operation time, operation time per screw, bleeding volume, or spinal curve correction outcomes between the two techniques. 3D-printed drill guides offer a superior alternative to FH techniques in improving pedicle screw accuracy and reducing complication rates for CS surgery without increasing operation time or bleeding. While promising, the limited sample size and focus on a single geographic region highlight the need for further multicenter studies to validate these findings and explore broader clinical applications.