LESI LESI Fluoroscopy and Imaging Guidance

Question 1

Fluoroscopic guidance for LESI is recommended over blind (landmark-based) injections primarily because:

Accepted Answer

It confirms accurate needle placement and reduces the rate of inaccurate injections from approximately 30-40% to near zero

Answer

Studies show that blind epidural injections have inaccurate placement rates of 30-40%; real-time fluoroscopy with contrast confirmation reduces inaccurate placement rates to near zero.

Question 2

In fluoroscopic interlaminar LESI, the AP (anteroposterior) view is used primarily to:

Accepted Answer

Verify midline or paramedian needle position between the laminae

Answer

The AP fluoroscopic view confirms that the needle tip is positioned midline or paramedian between the target laminae before advancing to the epidural space.

Question 3

A 'Christmas tree' pattern of contrast spread on fluoroscopy during interlaminar LESI indicates:

Accepted Answer

Appropriate epidural spread along nerve roots

Answer

Epidural contrast spread radiating along multiple nerve root sleeves in a symmetrical pattern resembling a Christmas tree confirms proper epidural placement of the needle.

Question 4

Rapid disappearance of contrast on fluoroscopy during ESI, without epidural spread pattern, indicates:

Accepted Answer

Intravascular injection — injection should be stopped immediately

Answer

Rapid vascular washout of contrast (disappearing within seconds without epidural spread) indicates intravascular needle placement; the procedure must be stopped, the needle repositioned, and contrast re-injected to confirm epidural placement.

Question 5

The lateral fluoroscopic view during interlaminar LESI is used primarily to confirm:

Accepted Answer

Needle depth (anterior-posterior positioning in the spinal canal)

Answer

The lateral view confirms that the needle tip is at the appropriate depth within the posterior epidural space and has not advanced too far anteriorly toward the intrathecal space or nerve roots.

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI LESI Fluoroscopy and Imaging Guidance