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Abstract Objective To compare the accuracy and safety of 3D printing navigation template and computer navigation-assisted C2 pedicle and pars screws placement and explore the advantages of the 3D printing template based C2 screws placement.Methods 64 patients who underwentthe C2 pedicle screws and C2 pars screws insertion in our hospital were included.According to the different methods of screw placement，they were divided into the 3D printing navigation template group (group A) and the computer navigation group (group B).Group A was divided into two subgroups：A1 (C2 pedicle screw) and A2 (C2 parsscrew)；Group B was divided into B1 (C2 pedicle screw) and B2 (C2 parsscrew).Group A consisted of 32 patients，including 21 males and 11 females with a mean age of 47.2±11.1 years(27~64 years).All patients were treated with 3D printing navigation template between June 2015 and September 2018.Group B consisted of 32 patients，including 19 males and 13 females with a mean age of 45.6±10.4 years(25~60 years).All patients were treated with the computer navigation between January 2014 and September 2018.All patients underwent cervical X-ray，CT，MRI and CTA before surgery.The disease types，nail placement time，intraoperative blood loss，intraoperative fluoroscopy frequency were compared between the two groups.Besides，the VAS score and JOA score were compared before operation，3 days after operation，and 6 months after operation.All patients undertook cervical CT scan after surgery，and the accuracy of screw placement and the incidence of related complications in the two groups were compared according to Hlubek's new C2 screw grading standard and CT results.Results In the two groups，the time of screw placement and intraoperative fluoroscopy in group A were better than that in group B，and the difference was statistically significant (P＜0.05).The difference of intraoperative blood loss was not statistically significant (P＞0.05).There was no significant difference in preoperative VAS score and JOA score between the two groups (P＞0.05)，and VAS and JOA scores were significantly improved 3 days after surgery and 6 months after surgery，with statistically significant differences (P＜0.05).There was no significant difference between the two groups (P＞0.05).64 C2 screws were implanted in group A，and the accuracy rate of grade A was 95.31%，among which 52 screws were implanted in group A1，and the accuracy rate of grade A was 96.15%.12 screws were implanted in group A2，and the accuracy rate of grade A was 91.67%.64 C2 screws were implanted in group B，and the accuracy rate of grade A was 84.38%，among which 50 screws were implanted in group B1，and the accuracy rate of grade A was 84.00%.14 screws were implanted in group B2，and the accuracy rate of grade A was 85.71%.The accuracy of screw placement between group A and group B was statistically significant (P＝0.041)，and the accuracy of screw placement between group A1 and group B1 was statistically significant (P＝0.039).There was no significant difference between group A2 and group B2 (P＝0.636).There were no complications of blood vessel and nerve related to nail placement in both groups.Conclusion Although the placement of C2 pedicle screws and C2 pars screws by 3D printing navigation template and computer navigation implantation can provide higher accuracy，safety and clinical efficacy.The guide template technology is better than the navigation technology in the accuracy of C2 pedicle screw implantation.
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