Ninety-six patients with various spinal conditions were enrolled in a self-control randomized trial in which pedicle screws were placed using either the free-hand technique (n=248 screws) or a modified electronic conductivity device (ECD)(n=248 screws). Each patient served as their own control, with pedicle screws on one side placed using free-hand technique and on the other side using the ECD. The primary outcomes of interest were the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Secondary outcomes included the time required for each pedicle screw placement. Outcomes were assessed intraoperatively and postoperatively. Overall, the results of the study revealed that while both techniques demonstrated comparable accuracy rates (95.16% for free-hand vs. 96.77% for ECD, p=0.611), the use of the ECD significantly reduced radiation exposure (1.11 ± 0.32 vs. 1.30 ± 0.53, p<0.001) and procedure time (70.88 ± 30.51 vs. 101.82 ± 54.00 seconds, p<0.001). These findings suggest that the modified ECD technique offers similar accuracy while improving efficiency and safety in spinal fixation surgeries.