Spinal interventional radiology has witnessed substantial progress in recent years. Notable recent advances include expanded adoption of vertebral augmentation techniques, targeted thermal ablation combined with cement augmentation to treat spinal metastases, electrochemotherapy for radioresistant epidural metastases, improved precision in facet joint, medial branch, and sacroiliac interventions, basivertebral nerve ablation for vertebrogenic back pain and emerging applications of restorative neurostimulation, and minimally invasive neuromodulation for chronic mechanical back pain. This review provides an overview of recent advances in the field, emerging treatments, and predictions for future breakthroughs.