Question

Which patient is the best candidate for a lumbar steroid injection?

A. A 72-year-old woman who reports new onset of right lower-extremity pain from her back into her big toe in the past month. MRI demonstrates severe central spinal stenosis at L4-5 with multilevel degenerative disk disease, ligamentum flavum hypertrophy, and facet arthropathy.
B. A 41-year-old man with axial low back pain for 20 years, unchanged, refractory to pharmacologic management, with MRI demonstrating multilevel degenerative disk disease
C. A 64-year-old man with back and right leg pain, status post L4-5 laminectomy 6 months ago, with persistent right L5 radiculopathy, documented by EMG/NCV study
D. A 28-year-old woman, injured lifting a box at work a week ago, with back pain radiating to her groin and into her buttocks bilaterally. MRI demonstrates mild disk bulge at L5-S1, with no annular tear, nor any central canal stenosis or neuroforaminal stenosis.
E. None of these patients is a good candidate for lumbar epidural steroid injection.

Answer 1

The best candidate for a lumbar steroid injection is a 72-year-old woman with severe central spinal stenosis, multilevel degenerative disk disease, ligamentum flavum hypertrophy, and facet arthropathy.

Step-by-step explanation:

The best candidate for a lumbar steroid injection would be Option A: A 72-year-old woman with severe central spinal stenosis at L4-5, multilevel degenerative disk disease, ligamentum flavum hypertrophy, and facet arthropathy. The patient's symptoms of new onset right lower-extremity pain and the MRI findings are indicative of nerve compression and inflammation in the lumbar spine, which can be relieved by a steroid injection. This option also rules out the other patients who either have refractory low back pain, post-surgical complications, or a mild disc bulge without significant stenosis or radiculopathy.