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May 30, 1977


JAMA. 1977;237(22):2380-2381. doi:10.1001/jama.1977.03270490020010

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To the Editor.—  I was pleased to read the report of Batnitzky et al on iatrogenic intraspinal epidermoid tumors (237:148, 1977). I believe, however, that their conclusion that "myelography should be considered for every patient who has pain in the back or lower extremities and who has had previous lumbar punctures" is ill-advised and in fact not warranted by their own case material. If every patient who had back pain and a previous lumbar puncture underwent myelography, the vast majority of the studies would be negative. In fact, each of the patients in the article had back or radicular pain accompanied by abnormal findings on neurological examination, and, given the history in two of their three patients of previous CNS tumor, myelography would certainly have been performed even without the history of previous lumbar puncture.The authors have done us a service by reminding us of the relationship between lumbar