{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:28:29Z","timestamp":1791829709596,"version":"4.3.4"},"reference-count":61,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Low-back pain (LBP) is a leading cause of disability worldwide. When symptoms persist beyond 4\u20136 weeks, when red flags are suspected, or when precise patient selection for procedures is needed, imaging\u2014primarily MRI (Magnetic Resonance Imaging)\u2014becomes pivotal. The purpose is to provide a pragmatic, radiology-first roadmap that aligns an imaging phenotype with anatomical targets and appropriate image-guided interventions, integrating MRI-based phenotyping with image-guided interventions for subacute and chronic LBP. In this narrative review, we define operational MRI criteria to distinguish radicular from non-radicular phenotypes and to contextualize endplate\/Modic and facet\/sacroiliac degenerative changes. We then summarize selection and technique for major procedures: epidural and periradicular injections (including selective nerve root blocks), facet interventions with medial branch radiofrequency ablation (RFA), sacroiliac joint injections and lateral branch RFA, basivertebral nerve ablation (BVNA) for vertebrogenic pain, percutaneous disc decompression, minimally invasive lumbar decompression (MILD), and vertebral augmentation for painful fractures. For each target, we outline preferred and alternative guidance modalities (fluoroscopy, CT, or ultrasound), key safety checks, and realistic effect sizes and durability, emphasizing when to avoid low-value or poorly indicated procedures. This review proposes a phenotype-driven reporting template and a care-pathway table linking MRI patterns to diagnostic blocks and definitive image-guided treatments, with the aim of reducing cascade testing and therapeutic ambiguity. A standardized phenotype \u2192 target \u2192 tool approach can make MRI reports more actionable and help clinicians choose the right image-guided intervention for the right patient, improving outcomes while prioritizing safety and value.<\/jats:p>","DOI":"10.3390\/diagnostics16020240","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T09:13:01Z","timestamp":1768209181000},"page":"240","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subacute and Chronic Low-Back Pain: From MRI Phenotype to Imaging-Guided Interventions"],"prefix":"10.3390","volume":"16","author":[{"given":"Giulia","family":"Pacella","sequence":"first","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5093-8692","authenticated-orcid":false,"given":"Raffaele","family":"Natella","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"},{"name":"Fondazione Trotula de Ruggiero, 84121 Salerno, Italy"},{"name":"Biomedical Research Centre, Gruppo Forte, 84124 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1444-2585","authenticated-orcid":false,"given":"Federico","family":"Bruno","sequence":"additional","affiliation":[{"name":"Ospedale S. Salvatore, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2866-6894","authenticated-orcid":false,"given":"Michele","family":"Fischetti","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Ricerche Radiologiche s.r.l., Via Pierluigi da Palestrina 1, 70056 Molfetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4024-1309","authenticated-orcid":false,"given":"Michela","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Brunese","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Brunese","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Forte","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, Gruppo Forte, 84124 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Forte","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, Gruppo Forte, 84124 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio","family":"Apollonio","sequence":"additional","affiliation":[{"name":"Radiology Department, \u201cS. Timoteo\u201d Hospital, 86039 Termoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Giuseppe","family":"Romano","sequence":"additional","affiliation":[{"name":"Unit of Diagnostic and Interventional Neuroradiology, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-5344","authenticated-orcid":false,"given":"Marcello","family":"Zappia","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1002\/pmrj.12930","article-title":"Clinical practice guidelines on interventional management of low back pain: A synthesis of recommendations","volume":"15","author":"Olivier","year":"2023","journal-title":"PM&R"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1148\/rg.2020190185","article-title":"Mechanisms and Origins of Spinal Pain: From Molecules to Anatomy, with Diagnostic Clues and Imaging Findings","volume":"40","author":"Aristides","year":"2020","journal-title":"RadioGraphics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/papr.13317","article-title":"1. 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