LESI LESI Patient Selection and Contraindications 2

Question 1

A patient allergic to iodinated contrast media who requires fluoroscopic LESI should be:

Accepted Answer

Pre-medicated with corticosteroids and antihistamines before contrast use, or procedure performed under ultrasound guidance

Answer

Patients with contrast allergy can undergo ESI after standard allergy pre-medication protocol (corticosteroids and antihistamines), or alternative guidance methods such as ultrasound can be used to avoid contrast.

Question 2

Which symptom pattern suggests that a patient is NOT an appropriate candidate for ESI as a primary treatment?

Accepted Answer

Cauda equina syndrome with acute bowel and bladder dysfunction

Answer

Acute cauda equina syndrome is a surgical emergency requiring urgent decompression — ESI would cause harmful delay and is contraindicated as primary management.

Question 3

Pregnancy is considered a relative contraindication to fluoroscopic LESI primarily because of:

Accepted Answer

Fetal radiation exposure from fluoroscopy and theoretical steroid teratogenicity

Answer

Fluoroscopy exposes the fetus to ionizing radiation, and systemic steroid absorption carries theoretical risks to the developing fetus, making fluoroscopic ESI a relative contraindication in pregnancy.

Question 4

A patient with uncontrolled coagulopathy (platelet count 40,000/μL) requires LESI. The appropriate action is:

Accepted Answer

Postpone until platelet count is optimized above acceptable threshold (typically 70,000-100,000/μL)

Answer

A platelet count below 70,000-100,000/μL significantly increases hemorrhagic risk; ASRA guidelines recommend optimizing platelet count before proceeding with neuraxial procedures.

Question 5

In which clinical scenario is LESI best supported by evidence as providing meaningful benefit?

Accepted Answer

Acute disc herniation with radiculopathy of less than 3 months duration

Answer

The strongest evidence supports LESI for acute radiculopathy from disc herniation of shorter duration, where the inflammatory component is active and corticosteroids can provide meaningful short-term benefit.

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI LESI Patient Selection and Contraindications 2