Sixty-six patients with lower back and unilateral lumbosacral radicular pain were randomized to receive up to 3 fluoroscopy-guided epidural steroid injections via an oblique interlaminar approach (n=33) or a transforaminal approach (n=33). The primary outcome of interest was pain score measured with a Visual Analogue Scale (VAS). Additional outcomes of interest included function measured with the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ), patient satisfaction, central and contralateral epidural contrast spread, and the incidence of adverse events. Outcomes were measured at 0, 2, 4, 8 and 12 weeks follow-up. Results revealed no statistical significant differences between the two approaches in VAS pain scores at all timepoints, as well as ODI scores and RMDQ scores at 12 weeks follow up (p>0.05 for all). Ventral epidural contrast spread was statistically significantly higher in the transforaminal group compared to the oblique approach group at 2 weeks follow-up (p=0.013). However, contralateral epidural contrast spread was statistically significantly higher in the oblique approach group at 0, 2, and 4 weeks follow-up (p<0.05 for all). Furthermore, patient satisfaction was similar between groups, except the % of patients that were somewhat dissatisfied with treatment which was statistically significantly higher in the oblique approach group (p=0.015). Moreover, 3 cases of paresthesia were observed in the oblique approach group. Additionally, 9 cases of motor weakness and 4 cases of motor weakness were observed in the oblique approach and transforaminal approach groups, respectively.