Introduction Navigation and robotic systems enhance precision in spinal deformity correction but remain inaccessible in many resource-limited settings due to cost and infrastructure demands. This study evaluates a low-cost, paper-based preoperative planning method using serial radiographs and CT scans to reconstruct pedicle anatomy, curvature patterns, screw trajectories, and osteotomy strategies—imprinted on plain paper—for severe, rigid, and neglected spinal deformities.

Material and Methods: Thirty-two patients (mean age: 18.9 ± 5.4 years) underwent corrective surgery planned with the imprinted paper-based technique. Preoperative imaging was manually analyzed to reconstruct spinal anatomy and simulate instrumentation. Surgical and radiographic outcomes were compared with published navigation-assisted benchmarks.

Results: Preoperative Cobb angles ranged from 81.6° to 110.2° (mean 94.8° ± 7.3°) and improved postoperatively to 23.8°–40.6° (mean 31.2° ± 4.6°), yielding correction rates of 61.9%–76.5% (mean 68.4% ± 4.1%). Screw placement accuracy was 89.8%–97.0% (mean 93.9% ± 2.2%), with malposition rates of 2.0%–6.1% (mean 3.7% ± 1.1%). Operative times ranged from 6.1 to 7.8 hours (mean 6.9 ± 0.5 hours), comparable to complex navigation-assisted surgeries. Neurological complications occurred in four patients (12.5%), all transient and resolved without permanent deficit. Estimated cost savings were 82%–88% compared to navigation-equipped procedures. At 15–26 months follow-up (mean 20.4 ± 2.6 months), all patients maintained stable correction and solid fusion.

Conclusion: Preoperative radiographic and CT evaluation imprinted on plain paper is a scientifically robust, cost-effective, and accurate alternative to navigation- or robot-assisted techniques for severe spinal deformity correction. Comparable correction rates, screw accuracy, and operative times, coupled with manageable complication rates, make this method a practical solution for delivering high-quality spine care in resource-limited environment.