Percutaneous spine procedures can be performed with computed tomography (CT) guidance. The use of CT guidance is cumbersome for procedures where an oblique needle trajectory is imposed by the spatial orientation of the spine, often requiring complex needle triangulation relative to the true axial scan plane. We describe a procedural modification to overcome this limitation. A combination of variable CT gantry tilt, and strategic bolster placement under the patient can be used to obtain optimal imaging planes for guidance along the desired needle trajectory. The needle is aligned with the CT gantry laser beam to guide the needle access to the target, maintained within a single CT slice. We describe our clinical experience using the modified procedure relative to the conventional technique, and provide representative examples.