Balling H - Expert conducted a prospective single-center cohort study to objectify the assumptions suggesting that implementation of 3D-navigation in the operating theater is complex, time consuming, and radiation intense by determining navigation-related learning curves in lumbar single-level posterior fusion procedures using 3D-fluoroscopy for real-time image-guided pedicle screw (PS) insertions. Findings suggested that in newly inaugurated O-arm based image-guidance it was possible to perform lumbar PS insertions at constantly high accuracy, even without prior experience in navigated techniques. The author noted a considerable decrease in the navigation-related time demand due to accelerating workflow preceding skin incision. Reducibility of procedural 3D-radiation dose to a fraction (13.2%) of a lumbar diagnostic non-contrast-enhanced computed tomography scan’s radiation dose was seen.