LESI LESI Post-Procedure Care and Outcomes 2 — Questions and Answers
Question 1: Physical therapy initiated after LESI is recommended primarily because:
- Steroids alone are curative and therapy is unnecessary
- Pain relief from ESI provides a window of opportunity to participate in rehabilitative exercise (Correct answer)
- Physical therapy reverses disc herniation
- Therapy is required by insurance companies before coverage is approved
Correct answer: Pain relief from ESI provides a window of opportunity to participate in rehabilitative exercise
ESI provides a window of reduced pain during which patients can more effectively engage in physical therapy and rehabilitation, addressing underlying deconditioning and movement dysfunction.
Question 2: Which functional outcome measure, assessing disability from low back pain, is frequently used alongside pain scores in ESI outcome studies?
- Glasgow Coma Scale
- Oswestry Disability Index (ODI) (Correct answer)
- PHQ-9 depression screening
- Modified Rankin Scale
Correct answer: Oswestry Disability Index (ODI)
The Oswestry Disability Index is a validated, 10-item questionnaire measuring the impact of low back pain on daily activities and is widely used in ESI outcome research.
Question 3: What percentage of patients with acute disc herniation-related radiculopathy typically experience significant improvement from LESI compared to placebo in randomized trials?
- Less than 10%
- 30-60% report meaningful short-term improvement over control (Correct answer)
- 90-100% are completely cured
- 50-80% avoid surgery permanently
Correct answer: 30-60% report meaningful short-term improvement over control
Randomized controlled trials demonstrate that 30-60% of patients with disc herniation-related radiculopathy experience meaningful short-term pain reduction with ESI compared to placebo injections.
Question 4: ESI has been shown in controlled studies to reduce the need for surgery by approximately what percentage in patients with lumbar radiculopathy?
- 0% — no effect on surgical rates
- 20-30% reduction in near-term surgical rates (Correct answer)
- 80-90% avoidance of surgery permanently
- 100% of patients avoid surgery if they receive 3 injections
Correct answer: 20-30% reduction in near-term surgical rates
Studies suggest ESI reduces near-term surgical rates by approximately 20-30% in patients with radiculopathy, providing a bridge to natural history recovery rather than eliminating surgery need permanently.
Question 5: Which symptom should prompt the physician to schedule urgent follow-up (within 24-48 hours) rather than routine follow-up after LESI?
- Mild soreness at injection site
- New onset bowel or bladder dysfunction after the procedure (Correct answer)
- Temporary numbness in the injected dermatome lasting 2 hours
- Mild headache resolved with rest and hydration
Correct answer: New onset bowel or bladder dysfunction after the procedure
New bowel or bladder dysfunction after ESI may signal cauda equina compromise from an epidural hematoma or abscess, requiring urgent evaluation rather than watchful waiting.
Question 6: The evidence for LESI in the treatment of lumbar spinal stenosis compared to disc herniation is:
- Stronger for stenosis than for disc herniation
- Similar efficacy for both conditions
- Weaker for stenosis — evidence shows more limited and shorter duration of benefit (Correct answer)
- ESI is contraindicated for lumbar stenosis
Correct answer: Weaker for stenosis — evidence shows more limited and shorter duration of benefit
Evidence for ESI in lumbar spinal stenosis shows more modest and shorter-duration benefit compared to disc herniation, because stenosis involves structural (bony and ligamentous) rather than primarily inflammatory nerve root compression.
LESI LESI Post-Procedure Care and Outcomes 2
Physical therapy initiated after LESI is recommended primarily because: