Chronic spinal pain is a significant issue in the geriatric population, often resulting from degenerative changes such as facet joint arthritis, disc degeneration, and spinal stenosis. Timely and precise management of these conditions is critical to improving quality of life and preventing functional decline in elderly patients. Spinal interventions, including spinal nerve root blocks, epidural steroid injections, medial branch blocks, and rhizotomies, provide minimally invasive solutions tailored to this demographic’s unique needs. This chapter explores these procedures in detail, highlighting their indications, technical considerations, and patient-specific challenges, such as anatomical variability and comorbidities common in the aging population. Imaging modalities, including fluoroscopy, computed tomography, and ultrasound imaging, are essential tools for procedural guidance, ensuring accuracy and reducing complications. Awareness of age-related changes, such as reduced bone density and ligamentous thickening, is vital for navigating technical complexities and mitigating risks like infections, hematomas, and medication side effects. By emphasizing a patient-centered approach, the chapter underscores the importance of preprocedural assessment, imaging-guided precision, and individualized follow-up care to optimize outcomes. These interventions, when thoughtfully applied, not only provide effective pain relief but also enhance mobility and quality of life in elderly patients, addressing the growing demand for minimally invasive solutions in an aging population.