Spinal instrumentation and frameless stereotaxy are two separate fields in neurosurgery that have rapidly advanced in recent years. The application of stereotaxis to spinal surgery has previously been limited by the inaccuracy of surface mounted reference points. The development of frameless stereotaxy using anatomical registration techniques has overcome this problem and has allowed stereotactic techniques to be successfully applied to spinal surgery at our institution. We tested our frameless spinal stereotactic technique in cadaver studies with optimal screw placement. The technique is currently undergoing preliminary clinical evaluation. We review the technique and its application to spinal instrumentation.