[Objective] To observe and compare the clinical effect of 3D printing assisted placement of upper cervical pedicle screws with manual placement. [Methods] From May 2010 to May 2019, 18 patients who met the inclusion criteria were selected for the study. In the 3D group, 10 cases were treated with individualized 3D printing guide plate to guide upper cervical pedicle screw placement. In the free hand group, 8 cases were nailed with the free hand method. [Results] All patients successfully completed the operation, all operations were completed by the same group of spinal surgeons, and all patients were followed up. In 3D group, 40 atlantoaxial pedicle screws were implanted in 10 patients, and the quality rate of screw placement was 97.50%; 32 atlantoaxial pedicle screws were implanted in 8 patients in the unarmed group, and the quality rate of the screws was 81.25%, with a statistical difference (P<0.05). In 3D group, there was no significant difference in the diameter and length of pedicle screws and the distance from the posterior midline between the simulated surgical placement and the software virtual placement (P>0.05). [Conclusion] Compared with the traditional manual nail placement method, 3D printing technology has higher accuracy, better surgical effect and better prognosis.