Our analysis is the largest study to date on pedicle screw placement. Pedicle screw placement via robotics was found to be superior due to its low misplacement rates compared to other modalities. Intraoperative 3D fluoroscopic navigation was found to have comparable misplacement rates. In addition, pedicle screw placement accuracy with robotics has continued to improve over time. This speaks to both the stability of the technology and the potential for continued improvement with new and more accurate robotic systems.