LESI LESI Patient Selection and Contraindications 1

Question 1

Which condition is an ABSOLUTE contraindication to lumbar ESI?

Accepted Answer

Active systemic infection or local infection at the injection site

Answer

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?

Accepted Answer

INR > 1.5

Answer

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?

Accepted Answer

Radicular pain from nerve root compression or inflammation

Answer

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?

Accepted Answer

Immunocompromised patients and those with poorly controlled diabetes

Answer

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?

Accepted Answer

4-5 days

Answer

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.

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI LESI Patient Selection and Contraindications 1