LESI LESI Techniques and Approaches

Question 1

The interlaminar epidural approach at lumbar levels is typically performed with the patient in what position?

Accepted Answer

Prone with a pillow under the abdomen to flex the lumbar spine

Answer

Lateral decubitus with knees drawn to chest

Answer

Supine with knees elevated on a bolster

Answer

Sitting upright leaning forward over a pillow

Question 2

Which method is considered the most reliable for confirming correct epidural needle placement during a lumbar ESI?

Accepted Answer

Fluoroscopic contrast injection

Answer

Loss of resistance to saline

Answer

Loss of resistance to air

Answer

Aspiration for blood or cerebrospinal fluid

Question 3

In the transforaminal LESI approach, where is the needle tip ideally positioned under fluoroscopic guidance?

Accepted Answer

In the superior-anterior quadrant (safe triangle) of the neural foramen

Answer

At the 6 o'clock position of the neural foramen

Answer

At the medial border of the pedicle on the AP view

Answer

Adjacent to the spinous process in the midline

Question 4

The caudal epidural approach accesses the epidural space through which anatomical opening?

Accepted Answer

The sacral hiatus at the base of the sacrum

Answer

The interlaminar space at L5-S1

Answer

The S1 neural foramen

Answer

The posterior sacral foramina at S2-S4

Question 5

Which epidural approach provides the most targeted steroid delivery to a specific spinal nerve root?

Accepted Answer

Transforaminal approach

Answer

Midline interlaminar approach

Answer

Caudal approach via sacral hiatus

Answer

Paramedian interlaminar approach

Question 6

The 'loss of resistance' technique during epidural needle advancement detects the transition from which structure into the epidural space?

Accepted Answer

Ligamentum flavum to epidural space

Answer

Subcutaneous fat to paraspinal muscle

Answer

Paraspinal muscle to interspinous ligament

Answer

Dura mater to subarachnoid space

Question 7

Which needle type is most commonly used for interlaminar lumbar epidural steroid injections?

Accepted Answer

Tuohy (curved bevel) epidural needle

Answer

Quincke (cutting bevel) spinal needle

Answer

Sprotte (pencil-point) spinal needle

Answer

Chiba (thin-wall) needle