Conventional imaging techniques are of limited usefulness in spinal navigation, due to their lack of a "three-dimensional perspective." An interactive image-guided approach has been developed that provides a three-dimensional image-space representation of surgical space, using a specially designed referencing system and computer workstation. The system is described and results from laboratory tests and clinical cases are reported. It is concluded that interactive image-guided stereotaxis can be a valuable tool in spinal localization because of its degree of precision and the increased margin of safety it can offer.