Background: Cervical radiculopathy is a pain due to compression of a cervical nerve root (CNR). Cervical spine injection conducted under fluoroscopy, computed tomography (CT) or ultrasound (US) guidance to identify and confirm the target nerve root. Ultrasound permits good visualization of the soft tissue which includes blood vessels in the foramen and around the nerve root. Aim: To evaluate the functional improvements, the effectiveness, and the safety of cervical selective nerve root block (CSNRB) using ultrasound guidance and to find out if there are any advantages while using fluoroscopy in addition to ultrasound. Methods: This study included 68 patients with Cervical radiculopathy and were randomly divided into, group I (n=34) underwent ultrasound -guided CSNRB and group II (n=34) underwent ultrasound and fluoroscopic-guided CSNRB. The outcomes evaluations were neck disability index (NDI), numerical rating scale (NRS), success rate, procedure duration, patient satisfaction, the accuracy of cervical level and any complications. Results: There was a significant decline in the NDI and NRS in both studied groups compared to the corresponding baseline values during the follow up period one week,1, 2, 3 months (P< 0.001) with no significant difference in between groups. Group I showed significant shortening in the procedure duration 5 (3 - 6) minutes while group II 7 (4 - 8). The success rate in group II was higher than group I after one week with no significant difference in between the two groups. There was no significant difference between the two groups regarding the level of patient satisfaction and the incidence of adverse events. Conclusion: Ultrasound guided CSNRB displayed significant improvement in NDI and NRS, with no significant difference when combined with fluoroscopy. The procedure time was significantly decreased in ultrasound group, while the success rate was higher in combined group with no significant difference. Patient satisfaction and side effects had no significant difference between groups.