Objective <p>The accuracy of pedicle screw placement varied in the literature from 27.6% in earlier series to 98.3% in later series. A systematic review of articles from 1990 to 2018 showed the accuracy rates of 95.5%, 93.1%, 91.5%, and 90.5%, for pedicle screws inserted by Computed Tomography (CT) navigation-guidance, free-hand technique, fluoroscopy-guidance, and robot-assisted technique respectively. A retrospective audit was conducted to know the accuracy of thoracic and lumbosacral pedicle screw fixation. The objectives of the study were to analyse the accuracy of screw placement from postoperative imaging, to know the rate of screw malposition, and to compare with the studies in the literature.</p> Methods <p>This was designed as an observational study. We did a retrospective analysis of patients who underwent pedicle screw fixation in the hospital from 2022 to 2025. Anatomical landmarks were used for the entry and fluoroscopy was done in each stage of screw advancement. Postoperative CTs were taken and patients were clinically monitored for complications.</p> Results <p>A total of 67 patients were included. A total of 320 screws were inserted. Three screws had Gertzbein grade 1 breach of less than 2&#xa0;mm, without any symptom. One patient had grade 2 breach of 2–4&#xa0;mm with radicular pain. So the accuracy is 98.75% of screws and 94.03% of patients. Two lumbar screws, one thoracic screw, and one sacral screw had misplacement. The accuracy according to the level were: 99.08% for lumbar, 98.39% for thoracic, and 97.5% for sacral levels.</p> Conclusions <p>Although this is a small series, the accuracy of pedicle screw insertion was better than those reported in literature. Combination of anatomical landmarks and conventional fluoroscopy helps in achieving high accuracy. The accuracy was maximum for lumbar level. Gertzbein grade 1 breach was asymptomatic, whereas grade 2 breach resulted in radicular pain.</p>