143 patients scheduled for spine surgery were randomized to undergo the procedure with either computer-assisted 3D intra-operative imaging or conventional 2D imaging with the aid of anatomical landmarks. The purpose of this study was to determine if 3D imaging resulted in significantly improved pedicle screw placement accuracy and reduced radiation exposure while maintaining similar operative times when compared to conventional methods. Results demonstrated that accuracy and operative time were comparable between groups when all patients were considered. In subgroup analysis, patients who underwent open surgical procedures with 3D imaging had significantly improved screw placement accuracy, but significantly increased radiation exposure and running time for pedicle screws.