During the past decade a disproportionate increase of spinal fusion procedures has been observed. Along with this trend image-guided spine surgery has been experiencing a renaissance in recent years. A wide range of different navigation systems is available on the market today. However, only few published studies assess the learning curves concerning these new spinal navigation techniques. So far a study on the learning curve for intraoperative 3D-fluoroscopy(3DFL)-navigated pedicle screw (PS) placement is still lacking.