Objective To discuss the clinical efficacy of 3D-printing occipital template assisted occipital screw placement in posterior occipital-cervical fusion. Methods from January 2012 to June 2019, a retrospective case-control study was conducted to analyze 21 patients receiving posterior occipital-cervical fusion with atlantoaxial instability or dislocation in Henan Provincial People's Hospital. They underwent 3D-printing occipital template assisted occipital screw placement. Then we collected time-consuming in operation, intraoperative blood loss, and length of occipital screw. Bone fusion was observed during follow-up. Results The operation time was 138.51 ±25.34 minutes, the intraoperative blood loss was 198.22 ±63.17 ml, and the average length of occipital screw was 10.62 ±0.95mm. The follow-up period was 6-24 months (12.66 ±5.21 months), and bony fusion was achieved in all patients. Conclusion The satisfactory length of occipital fixation screw can be obtained by using 3D printed occipital guide plate to assist occipital screw placement, which is beneficial to occipitocervical fusion.