Enhancing C2 pedicle screw placement in Hangman’s fractures: a comparative study of navigation and 3D printed guidance techniques Article Swipe
Rao Ruiqiang
,
Li Yi
,
Xiao Hai-yan
,
Wang MingGui
,
Liao Yixiu
,
Shang Song
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3389/fsurg.2025.1661304
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3389/fsurg.2025.1661304
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.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3389/fsurg.2025.1661304
- https://public-pages-files-2025.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1661304/pdf
- OA Status
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- References
- 22
- OpenAlex ID
- https://openalex.org/W4416160832
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4416160832Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.3389/fsurg.2025.1661304Digital Object Identifier
- Title
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Enhancing C2 pedicle screw placement in Hangman’s fractures: a comparative study of navigation and 3D printed guidance techniquesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
-
2025-11-13Full publication date if available
- Authors
-
Rao Ruiqiang, Li Yi, Xiao Hai-yan, Wang MingGui, Liao Yixiu, Shang SongList of authors in order
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-
https://doi.org/10.3389/fsurg.2025.1661304Publisher landing page
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https://public-pages-files-2025.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1661304/pdfDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://public-pages-files-2025.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1661304/pdfDirect OA link when available
- Cited by
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0Total citation count in OpenAlex
- References (count)
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22Number of works referenced by this work
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| abstract_inverted_index.(facet | 264 |
| abstract_inverted_index.0.032) | 229 |
| abstract_inverted_index.0.05). | 250 |
| abstract_inverted_index.0.97). | 208 |
| abstract_inverted_index.0.99). | 276 |
| abstract_inverted_index.37.5%; | 236 |
| abstract_inverted_index.artery | 29, 328 |
| abstract_inverted_index.differ | 263 |
| abstract_inverted_index.fusion | 56, 60, 259, 265, 270 |
| abstract_inverted_index.groups | 73 |
| abstract_inverted_index.injury | 329 |
| abstract_inverted_index.offers | 303 |
| abstract_inverted_index.safety | 10 |
| abstract_inverted_index.screw: | 137 |
| abstract_inverted_index.screws | 118, 215 |
| abstract_inverted_index.spinal | 129 |
| abstract_inverted_index.−19; | 184 |
| abstract_inverted_index.−9.1 | 159 |
| abstract_inverted_index.(65/66) | 196 |
| abstract_inverted_index.(77/78) | 199 |
| abstract_inverted_index.0.001). | 187 |
| abstract_inverted_index.0.008). | 239 |
| abstract_inverted_index.0.018). | 164 |
| abstract_inverted_index.January | 63, 66 |
| abstract_inverted_index.Methods | 40 |
| abstract_inverted_index.Overall | 188 |
| abstract_inverted_index.Results | 113 |
| abstract_inverted_index.analyze | 6 |
| abstract_inverted_index.artery, | 128 |
| abstract_inverted_index.between | 62 |
| abstract_inverted_index.divided | 70 |
| abstract_inverted_index.group), | 217 |
| abstract_inverted_index.healed; | 257 |
| abstract_inverted_index.hundred | 115 |
| abstract_inverted_index.improve | 341 |
| abstract_inverted_index.injury. | 133 |
| abstract_inverted_index.method: | 81 |
| abstract_inverted_index.pedicle | 12, 78 |
| abstract_inverted_index.printed | 102 |
| abstract_inverted_index.surgery | 19, 61, 288, 308 |
| abstract_inverted_index.system, | 91 |
| abstract_inverted_index.without | 126 |
| abstract_inverted_index.−1.5; | 161 |
| abstract_inverted_index.> | 249, 275 |
| abstract_inverted_index.24-month | 252 |
| abstract_inverted_index.Clinical | 105 |
| abstract_inverted_index.Compared | 334 |
| abstract_inverted_index.Patients | 68 |
| abstract_inverted_index.Type-III | 211 |
| abstract_inverted_index.accuracy | 8, 189, 221, 305, 343 |
| abstract_inverted_index.achieved | 219 |
| abstract_inverted_index.approach | 317 |
| abstract_inverted_index.cervical | 17, 51, 286 |
| abstract_inverted_index.cortical | 232 |
| abstract_inverted_index.fixation | 52 |
| abstract_inverted_index.fracture | 212 |
| abstract_inverted_index.improved | 244 |
| abstract_inverted_index.included | 42 |
| abstract_inverted_index.inserted | 125 |
| abstract_inverted_index.loss:152 | 167 |
| abstract_inverted_index.non-bone | 58 |
| abstract_inverted_index.patients | 44 |
| abstract_inverted_index.presence | 295 |
| abstract_inverted_index.reducing | 310 |
| abstract_inverted_index.subgroup | 213 |
| abstract_inverted_index.surgical | 332 |
| abstract_inverted_index.unstable | 349 |
| abstract_inverted_index.utilized | 88 |
| abstract_inverted_index.Hangman's | 21, 46, 290 |
| abstract_inverted_index.Objective | 0 |
| abstract_inverted_index.Operative | 134 |
| abstract_inverted_index.collected | 110 |
| abstract_inverted_index.compared. | 112 |
| abstract_inverted_index.effective | 299 |
| abstract_inverted_index.extremely | 348 |
| abstract_inverted_index.fractures | 47, 255 |
| abstract_inverted_index.operative | 311 |
| abstract_inverted_index.outcomes. | 333 |
| abstract_inverted_index.placement | 14, 80, 346 |
| abstract_inverted_index.posterior | 50 |
| abstract_inverted_index.template. | 104 |
| abstract_inverted_index.templates | 218, 283 |
| abstract_inverted_index.underwent | 49 |
| abstract_inverted_index.vertebral | 28, 127, 327 |
| abstract_inverted_index.3D-printed | 37, 122, 281 |
| abstract_inverted_index.Conclusion | 277 |
| abstract_inverted_index.beneficial | 321 |
| abstract_inverted_index.comparable | 304 |
| abstract_inverted_index.comparably | 245 |
| abstract_inverted_index.difference | 152, 177 |
| abstract_inverted_index.especially | 292 |
| abstract_inverted_index.follow-up, | 253 |
| abstract_inverted_index.forty-four | 117 |
| abstract_inverted_index.fractures, | 22, 291 |
| abstract_inverted_index.fractures. | 350 |
| abstract_inverted_index.inter-body | 269 |
| abstract_inverted_index.minimizing | 323 |
| abstract_inverted_index.navigated, | 120 |
| abstract_inverted_index.navigation | 34, 90, 103, 225, 336 |
| abstract_inverted_index.optimizing | 331 |
| abstract_inverted_index.reduction; | 156 |
| abstract_inverted_index.technology | 35 |
| abstract_inverted_index.templates) | 123 |
| abstract_inverted_index.templates. | 39 |
| abstract_inverted_index.effectively | 340 |
| abstract_inverted_index.high-riding | 27 |
| abstract_inverted_index.inter-group | 247 |
| abstract_inverted_index.penetration | 233 |
| abstract_inverted_index.technology, | 337 |
| abstract_inverted_index.0.11–10.2; | 205 |
| abstract_inverted_index.particularly | 23, 320 |
| abstract_inverted_index.radiological | 107 |
| abstract_inverted_index.retrospective | 2 |
| abstract_inverted_index.Post-operative | 240 |
| abstract_inverted_index.intraoperative | 77 |
| abstract_inverted_index.Intra-operative | 165 |
| abstract_inverted_index.patient-specific | 38, 282 |
| abstract_inverted_index.navigation-assisted | 307 |
| cited_by_percentile_year | |
| countries_distinct_count | 2 |
| institutions_distinct_count | 6 |
| citation_normalized_percentile |