Computer image guidance is one of the most significant recent technologic advancements in the field of spine surgery, because preoperative or intraoperative images can be used for multiplanar, three-dimensional intraoperative navigation. Laboratory and clinical studies have demonstrated that image guidance increases the safety and accuracy of a variety of spinal procedures. This article describes the application of intraoperative image guidance to spinal surgery, with a particular focus on minimal access procedures. Although commonly performed separately, these techniques can work in a complementary fashion. The apparent benefits and limitations of the various image-guided modalities are described.