Objective: The aim of this study is to assess the efficacy of ultrasound (US)-guided Caudal Epidural 
Steroid Injection (CESI) compared with fluoroscopy (FL)-guided CESI in patients with refractory 
back pain associated with radiculopathy. Methods This study was carried out on 50 persons selected 
from those attending the outpatient clinics of internal medicine department of Al-azhar university 
hospital, Assuit. From April 2018 to July 2018. The persons were divided into two groups: Group (A): 
included 25 patients who received US-guided CESI. They were 13 females and 12 males. Their age ranged 
from 30 to 60 years. Group (B): included 25 patients who received FL-guided CESI. They were 16 
females and 9 males. Their age ranged from 27 to 57 years. Results: About 40% of patients were females 
& 60% of the patients were males. About 42.5% of patients had disease duration of 3-5 years, 37.5% 
of patients had disease duration of 5-10 years, 10% of patients had disease duration of 10-20 years, 
5% of patients had disease duration of >20 years. About 15% of patients had BMI (18.5-24.9), 57.5% 
of patients had BMI (25-29.9), 27.5% of patients had BMI (>30). In this study There: There is a 
statistically significant difference between age and Ultrasound findings p. value <0.05. There is no 
significant difference between gender and Ultrasound findings. There is a statistically significant 
difference between disease duration and Ultrasound findings p. value<0.05. Conclusion: Caudal 
epidural injections are considered as the safest and easiest procedures of epidurals with minimal risk 
of coincidental dural puncture.US is excellent in guiding caudal epidural injection with similar 
treatment outcome as compared with FL-guided caudal epidural injection and ultrasound should be 
the preferred alternative when FL is not available. Caudal epidural steroid injection offer alternative 
effective approach in management of LDP of duration < 5 years, target level not L2-3/L3-4, -ve FST, 
LDP other than foraminal type and age <40 years and sufficient diameter of SH. Ultrasound is easy to 
perform with less complications and superior to FL in saving the procedure time owing to easy 
detection of the SH.