Image-guided navigation in spine surgery has evolved significantly since its inception, offering enhanced precision and safety for surgeons. This review outlines the historical development of image-guided navigation, from early fluoroscopic techniques to modern robotic and machine vision systems. The technology has become increasingly common in medical facilities, with studies showing a rise in its use over the past two decades. Image-guided navigation improves surgical accuracy, reduces the need for revision surgeries, and enhances operating room efficiency. It allows surgeons to visualize anatomical structures in real-time, aiding in the placement of pedicle screws and other instrumentation with greater accuracy. The evolution of imaging modalities, including X-ray, CT, and MRI, has played a crucial role in the development of image-guided navigation. Early systems relied on stereotactic principles and reference frames, while modern systems utilize 3D imaging, optical tracking, and augmented reality. These advancements have led to more accurate and efficient surgical procedures, with CT-based navigation showing superior accuracy compared to fluoroscopy. However, CT navigation involves higher radiation exposure, which must be balanced against its benefits. Current image-guided navigation systems include both active and passive technologies. Active systems use robotic assistance and predefined trajectories, while passive systems allow for greater flexibility. The choice between these systems depends on the specific surgical needs and the surgeon's expertise. The technical aspects of image-guided navigation involve preoperative planning, image registration, dynamic instrument tracking, and real-time visualization. These components work together to ensure accurate surgical outcomes. The clinical workflow of image-guided navigation includes the use of internal fiducials to confirm anatomical accuracy during surgery. This method has been shown to be highly effective in confirming the correct placement of surgical instruments. In conclusion, image-guided navigation has revolutionized spine surgery by improving precision, reducing human error, and enhancing patient outcomes. As technology continues to advance, the future of image-guided navigation looks promising, with further improvements in cost-effectiveness, education, and integration into standard clinical practice.Image-guided navigation in spine surgery has evolved significantly since its inception, offering enhanced precision and safety for surgeons. This review outlines the historical development of image-guided navigation, from early fluoroscopic techniques to modern robotic and machine vision systems. The technology has become increasingly common in medical facilities, with studies showing a rise in its use over the past two decades. Image-guided navigation improves surgical accuracy, reduces the need for revision surgeries, and enhances operating room efficiency. It allows surgeons to visualize anatomical structures in real-time, aiding in the placement of pedicle screws and other instrumentation with greater accuracy. The evolution of imaging modalities, including X-ray, CT, and MRI, has played a crucial role in the development of image-guided navigation. Early systems relied on stereotactic principles and reference frames, while modern systems utilize 3D imaging, optical tracking, and augmented reality. These advancements have led to more accurate and efficient surgical procedures, with CT-based navigation showing superior accuracy compared to fluoroscopy. However, CT navigation involves higher radiation exposure, which must be balanced against its benefits. Current image-guided navigation systems include both active and passive technologies. Active systems use robotic assistance and predefined trajectories, while passive systems allow for greater flexibility. The choice between these systems depends on the specific surgical needs and the surgeon's expertise. The technical aspects of image-guided navigation involve preoperative planning, image registration, dynamic instrument tracking, and real-time visualization. These components work together to ensure accurate surgical outcomes. The clinical workflow of image-guided navigation includes the use of internal fiducials to confirm anatomical accuracy during surgery. This method has been shown to be highly effective in confirming the correct placement of surgical instruments. In conclusion, image-guided navigation has revolutionized spine surgery by improving precision, reducing human error, and enhancing patient outcomes. As technology continues to advance, the future of image-guided navigation looks promising, with further improvements in cost-effectiveness, education, and integration into standard clinical practice.