We have come a long way, but we have a long way to go. The epidural steroid injection (ESI) therapy has been offered to the patients with radicular pain secondary to herniated disc. Evans was reportedly the first physician who published in Lancet in 1930. Since then, we have gone the entire spectrum of revisions and modifications. The technique is directly derived from the education of epidural anesthesia. For a long period, blind epidural was a routine practice, until the fluoroscopy added the advantage of confirmation of placement. The literature supports that the fluoroscopic-guided techniques have much higher chances of delivery of the medication into the epidural space. This is the target area where the nerve roots are located, the pathophysiological source of pain. According to White, the false-positive loss of resistance (LOR) is as high as 25%, and that can be decreased by 10-fold if fluoroscopy is used. However, there are some situations where fluoroscopy is contraindicated (first trimester) or not feasible due to gravid uterus.
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