The interventional procedures available to help diagnose and treat low back pain are numerous and expanding. With a growing population that is living longer, the incidence of low back pain will likely increase. New technology will continue to emerge in attempts to improve both evaluation and treatment of low back pain. Interventions and devices, however, do not undergo the same rigorous Food and Drug Administration approval process required for new pharmaceuticals to prove safety and efficacy. Devices and interventions for the spine evolve from physioanatomic theories of pain generation and are approved for use based on similar procedures and/or devices already in existence. They are most often used in clinical practice before establishing efficacy or long-term safety. This is true not only for the common interventions used currently but also for emerging treatments and treatments that have previously fallen out of favor only to return with a new twist (eg, chemonucleolysis, intradiscal steroid injection, coblation nucleoplasty, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency therapy, and biacuplasty). These may be legitimate treatments for low back pain, but further trials demonstrating their efficacy are needed to validate their use. Physiatrists treating low back pain should be cognizant that each procedure has a unique set of diagnostic and therapeutic capabilities, risks, limitations, and evidence of efficacy before integrating them into a comprehensive rehabilitation management plan. Indiscriminate use of interventions exposes patients to unnecessary risks and contributes to the socioeconomic burden of health care costs. Practitioners should endeavor to corroborate evidence-based treatments and support well-designed research. The results of these efforts will not only improve the quality of care for our patients but also provide a basis to negotiate reimbursement with third-party payers.