The incidence of pedicle screw breech varies based on anatomic location, body habitus, surgeon experience, spinal deformity, and surgical technique. Pedicle breeches have been reported to occur in up to 40% of screws. The purpose of this retrospective study was to compare the rates of revision of pedicle screw placement when using intraoperative C-arm vs O-arm (Medtronic, Memphis, Tennessee) assessment of pedicle screws. An economic analysis was also performed based on the estimated cost of pedicle screw revision. Four (1%) of 386 control patients required pedicle screw revision for a breeched pedicle screw not identified with intraoperative C-arm fluoroscopy. In the study group, none of the 331 patients returned to the operating room when O-arm was used to assess pedicle screw placement. Based on the 1% rate of returning to the operating room in the control group, the annual rate of cases nationwide requiring pedicle screw revision would be approximately 2300, with a cost of approximately $40,595,000.These results suggest that the use of intraoperative O-arm can reduce the need for revision of a breeched pedicle screw. This can potentially lead to a major cost savings.