SUMMARY Ultrasound-guided procedures are well established and utilized in the regional anesthesia and radiology practice. Conversely, there have been considerable difficulties in implementation of ultrasound in pain medicine. Ultrasonography has to compete with the more established modalities such as fluoroscopy and computed tomography; however, ultrasound has the advantage of radiation safety and point-of care imaging. It also allows direct visualization of tissue planes, blood vessels and nerves. Ultrasound-guided spine interventions are technically feasible and reasonably accurate when validated with conventional radiological modalities. Epidural, zygapophysial joint and caudal injection techniques have been published. The main pitfall of the ultrasound-guided spinal procedures lies in the inability to diagnose intravascular injections. Future technological improvements will help to solve this problem. Diagnostic spinal sonography may also contribute to the practice of medicine helping in the clinical workup of scoliosis and paraspinal pathology.