Surgery and interventional radiology of the spine

Interventional radiology (IR) techniques applied to the spine are so-called “minimally invasive” procedures aimed at relieving “simple” spinal pain and preventing serious spinal complications. Their rapid growth has enhanced the range of treatments available for osteoporotic and tumour-related spinal pathologies. Far from competing with conventional surgical techniques, they provide therapeutic solutions when surgery is considered too morbid and therapeutic abstention unacceptable. Imaging-guided percutaneous punctures offer considerable progress in providing relief, bone consolidation and tumour destruction. In fact, the benefit/risk balance of these procedures is often adapted to numerous clinical situations and responds to patient demand. IR allows therapeutic de-escalation in fragile patients for whom surgery is not reasonable, and offers an alternative solution for patients with few symptoms for whom surgery is unreasonable. Sometimes considered unjustified, sometimes insufficient, IR techniques find their place in the middle ground between conservative medical treatment and traditional surgery. This in-between approach is a third way, particularly suited to the relief of osteoporotic fractures with an unfavourable evolution and in the management of spinal bone metastases.