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. The study byPaweł Łajczak et alsystematically 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. The key findings of the study were: • 3D-printed drill guides demonstrated statistically significant improvements in screw placement accuracy (GR 0: OR 1.80, p = 0.015; GR 0 + 1: OR 3.69, p < 0.001) and reduced rates of severe screw misplacement (GR 3: OR 0.20, p = 0.019). • Additionally, the 3D printing group experienced significantly fewer complications (OR 0.16, p = 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. The authors concluded – “This meta-analysis reveals the significant role of 3D-printed drill guides in improving the accuracy and safety of pedicle screw placement in congenital scoliosis surgery. While these guides demonstrate significant advantages over traditional FH methods in terms of screw accuracy and complication reduction, their impact on other surgical outcomes remains still unclear. Future efforts should aim to improve this technology, expand its accessibility worldwide, and validate its efficacy to other modalities. With further technology improvements, 3D printing has the potential to become a valuable tool in spine surgery, offering a cost-effective and customizable solution to complex challenges like CS.” Further reading: 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 Paweł Łajczak, Anna Łajczak Indian Journal of Orthopaedics (2025) 59:888–900 https://doi.org/10.1007/s43465-025-01401-w