Although possessing a long history of use, the therapeutic use of epidural steroid injections still needs substantiation. Refinements in our understanding of the pathophysiology of radicular pain and in the techniques used to deliver depo-steroids to the target tissue will lead to improved clinical outcomes and fewer technique and drug-related side effects. Administration of epidural steroids at lumbar spine sites is more common than at cervical spine levels, although the same pain management concepts are applicable. Comparative studies are necessary to clearly define the advantages and disadvantages of the use of fluoroscopy and the transforaminal technique.