Ultrasound imaging of the lumbar spine and trunk is an increasingly powerful modality in neuromusculoskeletal (NMSK) medicine, offering real-time, radiation-free visualization for both diagnostic assessment and image-guided interventions. By clearly identifying structures such as the spinous process, lamina, facet joint, transverse process, and interlaminar space, clinicians can perform a range of targeted procedures with increased precision and safety. In the sagittal and transverse views, ultrasound allows for accurate localization of the intervertebral foramen, superior and inferior articular processes, and associated neural elements. These landmarks guide precise delivery of treatments, including medial branch blocks, interlaminar epidural injections, and foraminal nerve root blocks, all of which are integral to managing spine-related pain syndromes. Ultrasound also plays a vital role in interventions across the trunk. The transabdominal plane (TAP) block, performed along the anterior, mid, and posterior axillary lines, provides effective analgesia for abdominal wall and postoperative pain. Similarly, intercostal blocks performed via a thoracic parasagittal approach allow for targeted treatment of intercostal neuralgia and rib-related pain. This chapter presents detailed sonographic anatomy, step-by-step procedural guidance, and standardized scanning protocols to optimize outcomes in lumbar and trunk interventions. Emphasis is placed on safe needle trajectories, recognition of sonoanatomy, and integration into clinical practice.