With the growth of spinal surgery, in terms of numbers of operations, as well as the techniques and implants used, surgeons and spine physicians are turning more to imaging for clinical management decisions and surgical planning for spinal disorders. Medicolegal implications also make it mandatory in all cases. We discuss the importance of imaging in modern spinal surgical practice, with an emphasis on decision making in clinics, preoperative surgical work-up, and operative use, as well as in a postoperative setting when complications occur. The increasing use of endoscopic techniques has made the role of imaging even more important because precise techniques can enable viewing the sites of pathology with minimal damage to normal anatomy.