OBJECTIVE: To investigate the effect of C-arm fluoroscopic computer-assisted surgical navigation system on lumbar pedicle screw placement in the elderly. METHODS: Two hundred and eighty-six patients aged 65 years and older with lumbar degenerative disease undergoing posterior lumbar decompression and internal fixation were divided into two groups: navigated (153 patients) and unnavigated (133 patients), and the intraoperative blood loss, operative time and postoperative time to the floor were compared between the two groups. The Oswestry Dysfunction Index Questionnaire (ODD) was applied to the preoperative and final follow-up scores of all patients, and the improvement rate of ODI scores was calculated for 2 I-parity scores. RESULTS: In the navigated group, compared with the unnavigated group, the arch operation time [(27.6±6.3) min, (33.8±9.9) mini and bleeding volume [(135.7±21.1) ml, (165.4 clay 32.1) mid were reduced, and the postoperative time to the floor [(134.6±12.3) h, (169.0=23.9) h] was shortened; ODI score improvement rates [(76.6±3.7)%, (69,8–6.6)%] were improved. CONCLUSION: The C-arm fluoroscopic computer-assisted surgical navigation system can improve the efficacy of lumbar pedicle screw placement in the elderly.