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March 10, 1956


JAMA. 1956;160(10):899. doi:10.1001/jama.1956.02960450081024

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To the Editor:—  In the Dec. 31, 1955, issue of The Journal, page 1724, is an article "Intra-Articular and Paravertebral Injection of Cortisone in Osteoarthritis of Spine." I question the statement "Paravertebral injection of cervical vertebrae is relatively simple." Injection and infiltration of cervical paraspinal structures are potentially hazardous, and a lateral approach, as suggested by the authors, with the inadequate landmarks offered in the illustrations, should be seriously questioned. When a needle is inserted laterally "then advanced medially and anteriorly at a 45 degree angle until the transverse process is encountered and then directed toward the midline," two pitfalls may be encountered. Laterally, the vertebral artery may be pierced, and, medially, the ligamenta flava may be transfixed and the subarachnoid space entered, thus endangering the spinal cord.

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