Epidural steroid injections (ESI) can be an effective treatment of radicular pain, while also providing potential for functional improvement. There are 3 main interventional approaches including: interlaminar (IL), transforaminal (TF), and caudal. The risks and efficacy data vary between these routes of injection and the underlying pathology with the TF route having the most robust efficacy data. However, selecting an injection approach should be based on a patient’s clinical presentation, pathology, anatomy, consideration of the natural course of pain, and the unique risks and benefits of the particular technique.