Three-dimensional (3D) computed tomographic reformations are used as an adjunct to standard axial computed tomography (CT) in the evaluation of disorders affecting areas of complex anatomy such as the skull, the spine, the pelvis, hands and feet. 3D-CT can provide a clear impression of lesion extent, pattern, shape and proximity to adjacent structures. This unique spatial information potentially has a significant impact on decisions regarding resectability, surgical approach and repair. The basic requirements for high-quality 3D-reformations are an absence of patient movement and narrow-width transaxial sections. Spiral CT significantly contributes to fulfilling these requirements. In addition, spiral CT scan data can be used to produce the ultimate representation of the third dimension: a life-size palpable medical model. In this review we describe the process of three-dimensional reconstruction and highlight potential problems arising during 3D-imaging processing. Useful clinical applications of spiral CT for 3D-visualization of skeletal pathology are discussed.