Percutaneous interventional spine procedures are continually evolving. This article explores the current status, evidence, and controversial aspects of seven prominent image-guided minimally invasive interventions for painful spinal conditions: vertebral augmentation, basivertebral nerve ablation, interspinous process devices, minimally invasive lumbar decompression, radiofrequency medial branch ablation, high-frequency spinal cord stimulation, and multifidus muscle stimulation.