LESI LESI Patient Selection and Contraindications 1 — Questions and Answers
Question 1: Which condition is an ABSOLUTE contraindication to lumbar ESI?
- Poorly controlled diabetes
- Active systemic infection or local infection at the injection site (Correct answer)
- Mild coagulopathy (INR 1.2)
- Patient age over 80 years
Correct answer: Active systemic infection or local infection at the injection site
Active systemic infection or local skin infection at the injection site is an absolute contraindication to ESI because introducing a needle creates a pathway for infectious organisms to reach the epidural space.
Question 2: According to ASRA guidelines, what INR threshold generally requires postponement of ESI?
- INR > 1.2
- INR > 1.5 (Correct answer)
- INR > 2.0
- INR > 3.0
Correct answer: INR > 1.5
ASRA guidelines generally recommend an INR of 1.5 or less before proceeding with neuraxial injections to minimize bleeding risk.
Question 3: LESI is generally most effective for which type of pain generator?
- Axial low back pain from facet arthropathy
- Radicular pain from nerve root compression or inflammation (Correct answer)
- Sacroiliac joint pain
- Myofascial pain syndrome
Correct answer: Radicular pain from nerve root compression or inflammation
ESI is best supported for radicular pain (sciatica) caused by nerve root inflammation or compression from disc herniation or foraminal stenosis, rather than non-radicular axial back pain.
Question 4: Which patient population requires special caution with ESI due to increased susceptibility to steroid-related complications?
- Athletes in competitive sports
- Immunocompromised patients and those with poorly controlled diabetes (Correct answer)
- Patients under 40 years of age
- Patients with mild hypertension
Correct answer: Immunocompromised patients and those with poorly controlled diabetes
Immunocompromised patients and those with poorly controlled diabetes are at higher risk of infectious complications and glucose dysregulation from epidural corticosteroids.
Question 5: A patient on warfarin for atrial fibrillation needs ESI. How long should warfarin typically be held before the procedure?
- 12 hours
- 24 hours
- 4-5 days (Correct answer)
- 7-10 days
Correct answer: 4-5 days
Warfarin should be held for 4-5 days prior to ESI to allow normalization of the INR, with confirmation of INR ≤1.5 before proceeding.
Question 6: Which patient history indicates that an ESI may be futile or contraindicated due to prior surgical disruption of the epidural space?
- Prior physical therapy at the same spinal level
- Prior lumbar fusion at the target level with hardware (Correct answer)
- Prior lumbar ESI at the same level 6 months ago
- Prior steroid injection at a different spinal level
Correct answer: Prior lumbar fusion at the target level with hardware
Prior surgical fusion with instrumentation creates epidural scarring and hardware that can obstruct injectate spread and make accurate needle placement impossible or dangerous at that level.
LESI LESI Patient Selection and Contraindications 1
Which condition is an ABSOLUTE contraindication to lumbar ESI?