Epidural steroid injections (ESIs) are routinely used for the treatment of a variety of spinal ailments. Various methods for accessing the epidural space have been described over the decades. In the recent past, more and more emphasis has been on targeted delivery of drugs to the site of pain generation. Techniques differ according to the level of epidural space accessed. Use of fluoroscopic guidance can provide the most precise delivery of the drug. Although relatively safe, these injections can lead to morbidity and mortality if performed in a wrong manner. Several reports have been published recently describing disastrous results from transforaminal injections in the cervical spine. The importance of monitoring the spread of the injectate with injection of radio-opaque contrast material cannot be underestimated. The following chapter will summarize these techniques and highlight various technical considerations for the epidural injections.