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STUDY DESIGN Observational simulation study OBJECTIVE.: The goal of this study was to investigate the relationship between technical and non-technical skills in a simulated surgical procedure. SUMMARY OF BACKGROUND DATA Although surgeons' technical and non-technical skills during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and non-technical skills are related is limited. METHODS A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills were assessed using Objective Structured Assessment of Technical Skill (OSATS) scores and senior expert-evaluated VP outcome assessment. Non-technical skills were assessed with the Observational Teamwork Assessment for Surgery (OTAS). Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of prior VPs performed). RESULTS Surgeons' non-technical skills correlated significantly with their technical performance (τ=0.63; p = 0.006) and surgical outcome scores (τ=0.60; p = 0.007). This association was attenuated when controlling for surgeons' experience. CONCLUSION Our results suggest that spine surgeons with higher levels of technical skill levels also apply better communication, leadership and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery. LEVEL OF EVIDENCE 3.