Background and Aims With the addition of corticosteroids to the epidural injection in 1952,this procedure evolved as a cornerstone for the management of chronic back pain.

The introduction of fluoroscopy revolutionized the various techniques of epidural steroid injection(ESI) allowing easier access and different approaches to the spinal canal.

Fluoroscopy as the gold standard imaging tool of neuraxial procedures heavily relies on bony landmarks and contrast substance for needle placement,with the main disadvantage of radiation exposure.

Ultrasound as a well established imaging tool in regional anesthesia became very apealing also in the area of neuraxial procedures, bringing non-iradiating alternatives to the ESI.

The aim of this presentation is to illustrate the cervical and lumbar transforaminal ESI comparing the ultrasound to the gold standard of techniques.

Methods This review describes the techniques of Transforaminal Epidural Steroid Injections from the two imaging points of view, discussing avantages or disadvantages encountered in the recent medical literature.

Results The cadaver and human studies available in the last 15 years on lumbar US guided TESI from an axial and parasagital placement of the curvilinear probe showed good results and improvement of the techniques, though still needing tip needle confirmation with fluoroscopy.

In the meanwhile the cervical ultrasound selective nerve and transforaminal injections are more established techniques with good results over the time.

Conclusions Ultrasound is such an appealing imaging tool and offers many advantages over the more established fluoroscopy.

There are categories of patients who would tremendously benefit off of it, though further researches and improvment techniques needs to be done.