Precision in Cervical Spine Surgery: A Systematic Review and Comparative Meta-analysis of Navigated Guides for Safe and Effective Pedicle Screw Fixation

Objective: Cervical spine surgery presents unique technical challenges because of the small and complex anatomy of the cervical vertebrae and the high risk of neurovascular complications. Recent advances in 3-dimensional (3D) printing and navigation technologies have been introduced to improve screw placement accuracy, reduce surgical risk, and potentially shorten operative time. In this systematic review, we aimed to summarize currently available evidence and to describe selected studies evaluating 3D-printed navigation templates and intraoperative computer-assisted navigation systems for cervical pedicle screw placement.Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A literature search was performed for publications published between 2019 and 2024 using the following search terms: (“cervical spine” OR “navigation-assisted system”) OR (“3D printing template” OR “computer-assisted system”). A total of 130 articles met the initial screening criteria, of which 8 studies were included in the final analysis after application of predefined inclusion and exclusion criteria.Results: Eight studies were included in the final systematic review and network meta-analysis. The findings indicated that 3D-printed templates demonstrated higher accuracy, reaching up to 95.8% (risk ratio [RR], 1.17), and fewer deviations compared with computer-assisted navigation (RR, 1.05) and traditional techniques (RR, 1.0). Computer-assisted navigation showed greater heterogeneity across studies. However, no statistically significant difference in outcomes was observed between 3D-printed templates and computer-assisted navigation systems.Conclusion: Navigation-assisted cervical pedicle screw fixation is effective, and both 3D-printed templates and computer-assisted navigation techniques provide advantages in terms of accuracy and procedural safety.