Ultrasound (US) is an increasingly used imaging technique in interventional pain therapy allowing identification of soft tissues, vessels and nerves, without exposing patients or personnel to radiation. Imaging is performed continuously and the spread of the injected fluid can be visualized in real time. Spinal procedures which may be performed with US imaging are lumbar or cervical facet joint blocks, sacroiliac joint injections, caudal epidural injections and extraforaminal cervical or lumbar nerve root blocks. Limitations are the poor resolution of narrow-gauge needles, the loss of resolution with increasing working depth and possible interference of echoes from overlying structures with the image of the target area.