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Background  Instrumentation of the pediatric spine is challenging due to anatomical constraints and the absence of specific instrumentation, which may result in iatrogenic injury and implant failure, especially in occipito-cervical constructs. Therefore, preoperative planning and in vitro testing of instrumentation may be necessary.Methods  In this paper, we present a technical note on the use of 1:1 scale patient-specific 3D printed spinal models for preoperative assessment of feasibility of spinal instrumentation with conventional spinal implants in pediatric spinal pathologies.    Results  The printed 3D models fully matched the intraoperative anatomy and allowed a preoperative confirmation of the feasibility of the planned instrumentation with conventional screws for adult patients. In addition, the possibility of intraoperative model assessment resulted in better intraoperative sense of spinal anatomy and easier freehand screw insertion, thereby reducing the potential for iatrogenic injury. All 3D models were printed at the surgical department at a very low cost, and the direct communication between the surgeon and the dedicated specialist allowed for multiple models or special spinal segments to be printed for more detailed consideration.    Conclusions  Our technical note highlights the critical steps for preoperative virtual planning and in vitro testing of spinal instrumentation on patient-specific 3D printed models at 1:1 scale. The simple and affordable method helps to better visualize pediatric spinal anatomy and confirm the suitability of preplanned conventional spinal instrumentation, thereby reducing X-ray exposure and intraoperative complications in freehand screw insertion without navigation.

3D model-assisted instrumentation of the pediatric spine: a technical note