LESI LESI Patient Selection and Contraindications 3

Question 1

The duration of radicular symptoms most predictive of a successful response to LESI is:

Accepted Answer

Sub-acute radiculopathy (3-12 months)

Answer

Patients with sub-acute radiculopathy (3 weeks to 12 months) tend to show the best response to ESI, as sufficient neural inflammation is present but irreversible fibrosis has not yet developed.

Question 2

Which imaging finding on MRI most strongly predicts a favorable response to transforaminal LESI?

Accepted Answer

Focal subarticular disc herniation with corresponding nerve root compression and signal change

Answer

A focal disc herniation with direct nerve root compression and edema/signal change on MRI correlates best with an inflammatory pain generator that is likely to respond to epidural corticosteroids.

Question 3

Before performing LESI, a patient should be screened for allergy to which class of medications?

Accepted Answer

Local anesthetics, corticosteroids, and iodinated contrast

Answer

Pre-procedure allergy screening should include local anesthetics, corticosteroids, and iodinated contrast agents, as all three are typically used during an ESI procedure.

Question 4

Which comorbidity requires informing the patient that ESI may cause a prolonged elevation of blood pressure?

Accepted Answer

All of the above require this counseling

Answer

Hypertensive patients should be counseled that systemic steroid absorption can transiently elevate blood pressure, requiring monitoring and possible antihypertensive adjustment after ESI.

Question 5

A patient with an implanted spinal cord stimulator (SCS) at L1 requires LESI at L4-L5. What is the primary concern?

Accepted Answer

Needle trauma to the SCS lead and risk of epidural hematoma at the SCS site

Answer

The primary concern is physical trauma to the SCS lead during needle placement and the risk of epidural hematoma formation at the implant site, which can cause device malfunction or neurological injury.

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI LESI Patient Selection and Contraindications 3