Cervical Interlaminar Versus Transforaminal Epidural Steroid Injection

Inclusion Criteria: * \- aged \>18, capable of understanding and providing consent in English, capable of complying with the outcome instruments used, capable of attending all planned follow up visits * unilateral cervical radicular pain as defined by arm pain or shoulder girdle pain/periscapular pain with or without neck pain of at least 2 weeks. * 7 day average of numeric pain rating score (NPRS) for arm pain or shoulder girdle/periscapular pain of at least 5/10 at baseline evaluation * MRI (or CT if MRI not available) shows one or two level cervical disc herniation(s) or disc osteophyte complex(es) between levels C4-T1, corresponding in location with unilateral radicular pain, with or without neurological deficits. MRI or CT may show degenerative changes at other levels. * Patient consents to treatment with epidural injection in a shared decision-making process with the treating physician. * Pain duration of at least 2 weeks or more. Exclusion Criteria: * \- Neck pain is greater than arm pain or shoulder girdle/periscapular pain based on 7 day average NPRS * Those receiving remuneration for their pain treatment (e.g., disability, worker's compensation). * Those involved in active litigation relevant to their pain. * Those unable to read English and complete the assessment instruments. * Those unable to attend follow up appointments * The patient is incarcerated. * Spondylolisthesis at the involved or adjacent segments. * History of prior cervical surgery * Progressive motor deficit, and/or clinical signs of myelopathy. * Prior cervical epidural steroid injections. * Prior epidural steroid injection within the prior 12 months in any location within the spine. * Possible pregnancy or other reason that precludes the use of fluoroscopy. * Allergy to contrast media or local anesthetics. * BMI\>35. * Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis, lupus). * Active infection or treatment of infection with antibiotics within the past 7 days. * Medical conditions causing significant functional disability (e.g., stroke, COPD) * Chronic widespread pain or somatoform disorder (e.g. fibromyalgia). * Addictive behavior, severe clinical depression, or psychotic features.