Introduction: This study evaluates the role of the role of intraoperative ct in spinal surgery in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective cohort analysis. Materials and Methods: A retrospective cohort study was conducted on 320 patients from January 2016 to December 2023 at a tertiary care center. Patients were divided into iCT-guided (n=160) and Fluoroscopy-guided (n=160) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The iCT-guided group demonstrated significantly improved primary outcomes compared to Fluoroscopy-guided (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.