Spine oncological interventional radiology has become an integral component of multidisciplinary care for patients with neoplastic spinal disease. Beyond conventional vertebral augmentation, the field now encompasses image-guided biopsy, cementoplasty at complex spinal levels, percutaneous fixation, preoperative embolization of hypervascular tumors, thermal ablation, and electrochemotherapy.

These techniques address complementary objectives, including histological diagnosis, rapid pain relief, mechanical stabilization, facilitation of surgery, and local tumor control in selected patients. Advances in imaging guidance, procedural planning, and device technology have enabled increasingly precise and tailored interventions in anatomically constrained regions.

However, the spine remains a high-risk anatomical territory because of the proximity of the spinal cord, nerve roots, radiculomedullary arteries, and major vascular structures. Procedural safety therefore depends on careful patient selection, detailed knowledge of spinal anatomy, rigorous planning, and multidisciplinary coordination. Particularly challenging scenarios include cervical cementoplasty, percutaneous fixation of odontoid, pelvic, or sacral lesions, and tumor treatment in the presence of epidural extension.

This illustrated review summarizes the main minimally invasive techniques currently used in spine interventional oncology, with emphasis on their indications, technical principles, safety strategies, limitations, and integration into contemporary oncologic care pathways.