The number of spinal operations carried out per year is steadily increasing. Pedicle screw placement is the standard procedure for spinal stabilization but can be associated with severe complications. Intraoperative navigation can increase the accuracy of placement of the screws and a decisive role is played by the improvement in imaging devices. Nowadays, 3D-navigation is performed using intraoperative computed tomography or a flatpanel-3D C-arm. Computer navigation is a crucial aid especially for complex deformities or tumor cases. However, as yet no statistically significant reduction of complications could be shown using navigation compared to conventional procedures. With continuing development of intraoperative imaging and navigation it is hoped that screw positioning can be improved further.