Dr Nelson raises several points in his thoughtful letter. The first has to do with complications of administration of methylprednisolone acetate. Morbidity in any procedure is the ratio of complications to the number of procedures performed. Dr Nelson and his colleagues1 reported three complications in 23 patients (13%). Goldstein et al2 reported two complications in 31 patients (5.3%). Although there are no statistics available on the number of intrathecal methylprednisolone acetate injections performed throughout the world since 1960, the number must be impressive given the ease of administration and lack of better treatment modalities in the disease processes for which it has been used. Sehgal and Gardner3 reported over 1,000 injections with no complications, and six subjects in this series had autopsies that showed normal arachnoid and spinal cord.The second point bears on the production of arachnoiditis. Most references agree that the major concentration of intrathecally administered
Cohen FL. Methylprednisolone Acetate-Reply. Arch Neurol. 1979;36(10):662. doi:10.1001/archneur.1979.00500460096023
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