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Progressive pain in the back or lower extremities was the striking clinical feature in our three cases of intraspinal epidermoid tumors. In reviewing the literature, this has also been a prominent clinical presentation.
We did not advocate that myelography should be performed in every patient complaining of back or lower extremity pain who has had previous lumbar punctures. We used the word "consider," which is defined by Webster's Unabridged Third New International Dictionary of the English Language (1961) as "to think about with a degree of care or caution." Rather, we implied that the association of a previous lumbar puncture and lower extremity or back pain and the possible development of an intraspinal epidermoid tumor should be an added consideration or factor in deciding whether or not a myelogram should be performed.
Obviously, the total clinical picture has to be taken into consideration in making the final decision
Batnitzky S. Myelography-Reply. JAMA. 1977;237(22):2381. doi:10.1001/jama.1977.03270490020011
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