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Observational matched cohort study with computed tomography (CT) analysis of pedicle screw placement.Assess the clinical accuracy of computer-assisted fluoroscopy for the placement of thoracolumbar pedicle screws through a mature posterolateral fusion mass.Pedicle screw placement through an amorphous posterolateral fusion mass intuitively carries a higher risk of pedicle wall violation.Postoperative CT scans of 102 pedicle screws placed through a mature posterolateral fusion mass (n = 10 [T10–T12]; n = 92 [L1–S1]) were independently assessed and compared with a matched control (nonobscured anatomy) group. All screws were placed before any decompression using the FluoroNav system.In the fusion mass group, overall 81.4% of screws were completely within the pedicle. Seven medial and 12 lateral pedicle breaches occurred. Relative to the total number of screws, pedicle breaches were graded II (<2 mm) in 13.5%, III (2–4 mm) in 2.9%, and IV (>4 mm) in 2.0% of screws. The number and direction of pedicle breaches were not significantly different when compared with the control group. There were no clinically significant screw misplacements in either group.The use of computer-assisted fluoroscopy is safe and effective for the placement of thoracolumbar (T10–S1) pedicle screws through a posterolateral fusion mass without performing laminoforaminotomies.