Clinical applications of computerized frameless stereotactic image-guided spinal surgery continue to evolve. This article discusses several limiting factors regarding the use of this technology. It discusses the benefits of stereotaxy, which are better realized when there is a distortion of 'normal' anatomy because of previous surgery or severe deformity. The three-dimensional model helps the surgeon navigate the rotated and translated vertebrae. The technology can also be helpful when performing a posterior lumbar interbody fusion, to determine the orientation and depth of placement of the allograft or the cage.