Abstract:[Objective] To compare the early clinical outcomes of 3D printing assisted pedicle screw placement versus conventional free- hand technique for the upper cervical deformity. [Methods] From May 2010 to May 2019, 18 patients received atlantoaxial or occipitocervi- cal instrumented fusion for upper cervical deformity in our hospital. Of them, 10 patients had screws placed with 3D printed guider individu- ally, while the other 8 patients were by conventional hands-free technique. The early clinical and imaging data were compared between the two groups. [Results] All patients were successfully operated on with a total of 72 screws inserted, including 40 screws in the 3D group and 32 screws in the freehand group. The 3D group proved significantly superior to the freehand group in terms of operative time [(189.7±16.1) min vs (242.1±23.2) min, P＜0.001], intraoperative blood loss [(216.6±49.8) ml vs (385.0±23.5) ml, P＜0.001], placement time per screw [(3.3± 0.8) min vs (7.0±1.1) min, P＜0.001] and the number of X- ray exposure [(8.7±1.1) times vs (30.0±3.3) time, P＜0.001]. Radiographically, there were no significant differences between preoperative simulation and real operation in the 3D group regarding screw diameter, length and distance from the posterior median line (P＞0.05). The accuracy rate of screw placement in 3D group was significantly higher than that in freehand group (97.5% vs 81.3%, P＜0.05). [Conclusion] Compared with traditional handsfree screw placement, the 3D printing assisted pedicle screw placement has higher accuracy and improved surgical efficiency.