3D navigation options offer new opportunities for more precise navigation in spinal surgery, favor reduction of radiation exposure for the surgical team, and accelerate surgical workflow. Recently, the latest concept of “total navigation” using iCT NAV in spinal surgery has been introduced. Therefore, workflows have changed from what they were before using X-ray and fluoroscopy. Although several groups have described reduced radiation exposure for the surgical staff, fastest surgical workflows, and improved screw implantation accuracy, there is not enough evidence available to prove a significant benefit over the institutional costs.