Interventional techniques for the treatment of spinal disorders have developed rapidly in recent years, and many of them are increasingly used in clinical practice, including interventional diagnosis and interventional treatment. Diagnosis includes percutaneous puncture biopsy, CT discography, intervertebral disc manometry, and treatment includes CT-guided dorsal root perineural injection therapy, CT-guided joint injection therapy, CT-guided sacral canal cyst puncture aspiration and decompression, percutaneous vertebroplasty, vertebral body kyphoplasty, operative percutaneous disc decompression, arterial perfusion chemotherapy and embolization for spinal tumors, and the emerging percutaneous posterior lumbar interbody fusion. Interventional techniques have a promising clinical application and can be one of the directions of research for interventional radiologists. The importance of the spine as a pillar of the human body is self-evident, as it mainly carries the gravity of the upper body, participates in the composition of the posterior wall of the trunk, and protects the spinal cord and nerve roots as well as important organs such as internal organs. Although the spine is the “backbone” of the human body, it also has its vulnerable side, which is a good site for various benign and malignant diseases. For example, vertebral compression fractures are the most common fractures in the elderly, spinal metastases account for 30%-45% of bone metastases throughout the body, cervical spondylosis and lumbar disc herniation are common degenerative diseases of the spine. At present, the research and clinical application of interventional diagnostic and treatment techniques for spinal diseases in China, the most affected areas of human diseases, still have not attracted much attention from most interventional radiologists. In foreign countries, minimally invasive interventional techniques for spinal diseases are changing rapidly and have become one of the most important areas of interventional radiology research in this century, and many of these techniques have become increasingly mature, with the dissemination and application of new technologies becoming more widespread. I. Interventional diagnosis of spinal diseases 1, percutaneous vertebral body puncture biopsy In the past, biopsy of difficult spinal cases required open surgery to obtain material, which was traumatic and costly. Since Ball first applied percutaneous vertebral lesion puncture biopsy in the clinic, the clinical application has become increasingly widespread, proving that puncture biopsy is a safe, effective, and economical method of examination, with the literature reporting that CT-guided vertebral lesion puncture biopsy reaches 71%-95%, and currently percutaneous puncture biopsy technology has been recommended as the preferred method to replace open biopsy. In addition to completing tissue cytology, puncture biopsy can also be used for bacterial culture and drug sensitivity testing of infectious diseases. The image guidance equipment for percutaneous puncture biopsy is mainly based on X-ray fluoroscopy and CT, especially the latter with the advancement of multilayer spiral CT technology, CT three-dimensional guided puncture has promoted the safety, accuracy and success rate of the procedure, and the research of MSCT three-dimensional guided puncture and the development of puncture instruments is one of the current hot spots; because MRI is free from the risk of ionizing radiation, MRI guided puncture and the related The research of MRI-guided puncture and related puncture instruments is also one of the current directions of scientific research. 2, CT discography Discography began in 1948 at Lindblom, and has been gradually replaced by non-invasive CT and MRI examinations because of its low diagnostic sensitivity and specificity. In recent years, as the demand for discogenic pain treatment has increased, discography has taken on a new luster and is used for the diagnosis of disc localization in degenerative lesions of the lumbar spine, also known as the “discography” test, in which a pain consistent with the nature and location of the preoperative pain is stimulated during the injection of contrast into the disc. This test is of high value for the localization of the responsible intervertebral disc. The CT scan of the intervertebral disc after imaging, according to the shape of the distribution of the imaging and the overflow of the disc, can distinguish more accurately the degeneration of the disc and the rupture of the annulus fibrosus, as well as the direction and degree of rupture of the annulus fibrosus, which can guide the selection of the treatment plan. Percutaneous puncture manometry The pressure increase in the disc is one of the factors in the pathogenesis of disc herniation. Real-time dynamic monitoring of the pressure change in the disc before and after the intervention can quantitatively record the value of disc decompression and objectively reflect the degree of decompression treatment. In addition, real-time intravertebral disc pressure measurement can also directly reflect the biomechanical changes in the spine caused by the treatment of adjacent vertebrae. For example, the increase in intravertebral pressure after vertebroplasty can lead to a corresponding increase in pressure in adjacent vertebral discs, and the pressure can be transmitted to adjacent vertebrae, which partially explains the biomechanical mechanism of the vulnerability of adjacent vertebrae to fracture after PVP. Real-time pressure measurement of the intradural epidural space can be predictive of the prognosis of treatment. Steroid injection into the spinal dura has been used to treat lower back pain for more than half a century, but the traditional percutaneous injection therapy is a blind puncture without imaging guidance, and the efficacy depends on the experience of the operator, and the efficacy varies greatly from statistic to statistic, according to White’s study, even with experienced operators, the error rate of puncture needle placement is as high as 25%-30%. According to White’s study, even with experienced operators, the error rate of needle placement is as high as 25%-30%. PRT is a safe and effective interventional technique with few complications and almost non-invasive, and we believe it can be a popular technique for interventional radiologists. 2.CT-guided joint injection therapy Degenerative small arthritis and sacroiliac arthritis are common causes of lower back pain, CT guidance can accurately place a needle in the joint cavity, first inject a small amount of local anesthetic for diagnostic testing, the pain disappears, then confirm the responsible joint, and then inject steroid suspension. The efficacy can reach 80% in the near and middle term. 3.CT-guided sacral canal cyst aspiration and decompression For symptomatic sacral canal cysts, surgeons prefer surgical treatment, including laminectomy, cystectomy or partial resection and microsurgical resection and duralplasty, etc. However, surgical operation is more traumatic and has more complications. Through our preliminary clinical study, we showed that CT-guided sacral cyst aspiration and decompression is an effective minimally invasive treatment method, and it needs a large sample of cases to verify whether it can be the first-line treatment method for sacral cysts. 4.Percutaneous vertebroplasty and vertebral body kyphoplasty Percutaneous vertebroplasty is the most far-reaching minimally invasive treatment technique developed and promoted by interventional radiologists, as shown in the expanding scope of indications, including osteoporotic vertebral compression fractures, various osteolytic-based vertebral metastases, myeloma and vertebral hemangioma, etc. Geographically, the technology is spreading from Europe and America to Asia and Africa, from developed countries to developing countries. In terms of disciplines, in addition to interventional radiology, orthopedics, neurosurgery and even pain medicine are all scrambling to “get involved”. The development of percutaneous kyphoplasty, based on percutaneous vertebroplasty, is also being carried out in large numbers. At present, the hot spot of research has shifted to injectable bone cement material science, including low-temperature polymerization, anti-tumor, resorbable bone cement and other aspects of research. 5. Percutaneous disc decompression Percutaneous disc decompression is the most active research area in spinal interventional radiology, and new techniques are emerging like a flood of new techniques. The first is chemical ablation decompression, first reported by Smith in 1964, papain, and in recent years, collagenase and ozone have been widely used. The second is physical ablation and decompression, including laser vaporization decompression, radiofrequency ablation, electrothermoplasty, plasma ablation and cryoablation, with high temperature ablation and low temperature ablation. Third, mechanical nucleus pulposus decompression, including percutaneous puncture nucleus pulposus removal, discoscopic nucleus pulposus removal and transabdominal lumbar disc nucleus pulposus removal. There are many interventional methods with different efficacy, indications, complications and trauma, and there is no bulk control study yet. Selective arterial infusion chemotherapy and embolization of spinal tumors has the advantage of small systemic side effects, can control the effect of local intensive tumor killing, and can be combined with surgical resection to reduce intraoperative bleeding. However, attention should be paid to avoiding the spinal cord feeding arteries and preventing spinal cord injury during the treatment. 7, percutaneous posterior lumbar interbody fusion interbody fusion is a classic method for treating various chronic degenerative diseases of the lumbar spine, and more than 300,000 such operations are performed in the United States each year. Studies have shown that pathological changes such as paravertebral muscle ischemia, contracture, and loss of innervation lead to postoperative lumbar strength loss, chronic low back pain, and prolonged recovery time, etc. Exploring minimally invasive interbody fusion has been a research direction for more than 10 years. Percutaneous posterior lumbar interbody fusion (PPLIF) is an emerging treatment method for chronic lumbar degenerative diseases in the past 2 years. It has the advantages of shorter operative time, smaller incision, avoidance of heavy bleeding and fewer complications than traditional open spinal fusion surgery. The Scheufler controlled study reported statistically significant differences in operative time, intraoperative bleeding, and postoperative pain compared to open surgery, with an excellent clinical outcome rate of 87%.Folman reported the results of a prospective multicenter study showing an interbody fusion rate of nearly 99% with no serious complications.PPLIT is the basis for percutaneous myeloplasty PPLIT is based on percutaneous nucleus pulposus removal, scraping of the endplate cartilage, placement of a permanent titanium expander and bone graft to prevent gap collapse and fusion of the spine. Interventionalists can study the surgical procedure, the choice of bone graft, and the design of the expander in depth. 8, the problem of joint interventional treatment of spinal lesions spinal diseases due to the anatomical relationship, pathogenesis and etiology of complex, single means of treatment is often ineffective, the need for joint treatment. For example, the pathogenesis of degenerative lesions of the lumbar spine has factors of disc compression and chronic aseptic inflammation, which can significantly improve the efficacy if combined with disc decompression and elimination of peripheral nerve inflammation. Combination therapy is not only the combination of various interventional techniques within the discipline, but also requires interdisciplinary combination, such as the treatment of spinal metastases, vertebroplasty combined with arterial infusion chemotherapy and embolization can be used within the discipline to strengthen the vertebral body, reduce pain and locally control tumor growth, but other disciplines including medical oncology and radiotherapy are still needed to participate in the combination of treatment, from systemic to local comprehensive treatment, in order to improve the survival rate, reduce symptoms and improve the quality of life. However, there is still a need for other disciplines, including medical oncology and radiotherapy, to participate in combined treatment, from systemic to local, to improve survival, reduce symptoms and improve quality of life. Interventional radiology of the spine is maturing, and there is still a vast world waiting for interventional radiologists to open up. Interventional radiologists operating under the guidance of imaging equipment have inherent advantages and deep understanding, so interventional radiology of the spine should also be the responsibility of interventional radiologists, and interventional radiology of the spine needs a large number of interventional radiologists to continue to lead the academic trend, rather than give up.