LESI LESI Complications and Risks 1 — Questions and Answers
Question 1: Which is the most feared catastrophic complication of transforaminal lumbar ESI?
- Postdural puncture headache
- Spinal cord infarction causing paraplegia (Correct answer)
- Epidural hematoma
- Infection and epidural abscess
Correct answer: Spinal cord infarction causing paraplegia
Spinal cord infarction due to inadvertent intra-arterial injection of particulate steroid into a radiculomedullary artery is the most feared catastrophic complication of transforaminal LESI.
Question 2: Postdural puncture headache (PDPH) after ESI is caused by:
- Corticosteroid neurotoxicity
- Inadvertent dural puncture causing CSF leak (Correct answer)
- Epidural hematoma compressing the dura
- Local anesthetic toxicity
Correct answer: Inadvertent dural puncture causing CSF leak
PDPH results from inadvertent dural puncture with subsequent CSF leak, lowering intracranial pressure and causing the characteristic postural headache.
Question 3: What is the characteristic feature of postdural puncture headache that distinguishes it from other headaches?
- Occipital location only
- Positional — worse when upright, relieved when supine (Correct answer)
- Associated with fever and neck stiffness
- Unilateral and pulsating with aura
Correct answer: Positional — worse when upright, relieved when supine
PDPH is characteristically positional — it worsens significantly when the patient sits or stands and improves within minutes of lying flat due to changes in CSF pressure.
Question 4: An epidural abscess following LESI most commonly presents with which triad of symptoms?
- Nausea, vomiting, and headache
- Back pain, fever, and neurological deficits (Correct answer)
- Hypotension, bradycardia, and confusion
- Leg pain, paresthesia, and urinary retention
Correct answer: Back pain, fever, and neurological deficits
Epidural abscess classically presents with the triad of back pain, fever, and progressive neurological deficits, and represents a surgical emergency requiring prompt diagnosis.
Question 5: Intrathecal injection during an intended epidural injection can cause which life-threatening complication?
- Anaphylaxis
- Total spinal anesthesia with respiratory arrest (Correct answer)
- Pulmonary embolism
- Myocardial infarction
Correct answer: Total spinal anesthesia with respiratory arrest
Intrathecal injection of the full epidural dose can cause total spinal anesthesia with high motor block, respiratory paralysis, and cardiovascular collapse requiring emergency resuscitation.
Question 6: What is the approximate risk of inadvertent dural puncture during interlaminar LESI?
- Less than 0.5% (Correct answer)
- 1-3%
- 5-10%
- 15-20%
Correct answer: Less than 0.5%
The risk of inadvertent dural puncture during interlaminar LESI with fluoroscopic guidance is approximately 0.5% or less in experienced hands.
LESI LESI Complications and Risks 1
Which is the most feared catastrophic complication of transforaminal lumbar ESI?