LESI LESI Techniques and Approaches 1

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

The prone position with an abdominal pillow flexes the lumbar spine, widening the interlaminar space and facilitating needle entry into the epidural space.

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

Fluoroscopic contrast injection provides real-time visual confirmation of injectate spread within the epidural space and can detect intravascular or intrathecal misplacement.

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

The safe triangle (Kambin's triangle) in the superior-anterior foramen positions the needle near the nerve root sleeve while avoiding the exiting nerve and major radicular vessels.

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 sacral hiatus is a midline opening at the inferior end of the sacral canal formed by non-fusion of the S4-S5 laminae and is the entry point for the caudal approach.

Question 5

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

Accepted Answer

Transforaminal approach

Answer

The transforaminal approach deposits steroid directly at the ventral epidural space adjacent to the target nerve root's sleeve, providing site-specific delivery.

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI - Lumbar Epidural Steroid Injection Practice Test

LESI LESI Techniques and Approaches 1