September 26, 1966

Dangers of Spinal Injections Without Proper Diagnosis

Author Affiliations

From the Division of Neurosurgery, Department of Surgery, Western Reserve University School of Medicine and University Hospitals of Cleveland.

JAMA. 1966;197(13):1104-1106. doi:10.1001/jama.1966.03110130104035

A RECENT EDITORIAL has wisely emphasized the advisability that a qualified neurological surgeon perform intraspinal surgery.1 Of equal importance is a proper diagnosis when surgery is undertaken. There is a growing tendency toward relatively blind injection therapy, often done without standard diagnostic tests.2-5 Recent problems in patients who have undergone such therapy prompt this report.

We have encountered a large intradural extramedullary vascular lesion, grossly having the appearance of pseudoaneurysm, but pathologically shown to be an invasive hemangioendothelioma. This patient had had a chymopapain injection for presumed cervical disk disease at the same level two months earlier at another hospital. While we do not suggest a direct causal relationship between the tumor and previous chymopapain injection for presumed disk rupture, it is important to emphasize the necessity for thorough diagnostic studies before treatment. A second patient had epidural injections of steroids for sciatic pain without significant pretherapy study.