To the Editor.
—Nelson has recently reviewed the dangers of intraspinal injection of methylprednisolone acetate,1 and has concluded that methylprednisolone acetate is contraindicated for intrathecal or epidural injection. Nelson's conclusion is based on two premises: (1) both intrathecal and epidural injection are likely to produce neurotoxic effects, and (2) intrathecal and epidural steroid injections are ineffective in the treatment of sciatica.I agree with the premise that intrathecal injections of methylprednisolone acetate are potentially harmful. On the other hand, I am not convinced that epidural injection of long-acting corticosteroids are hazardous. We have performed approximately 4000 epidural steroid injections at the Medical College of Wisconsin, Milwaukee, mainly with triamcinolone diacetate (which contains the same concentration of polyethylene glycol as methylprednisolone acetate), over a 13-year period. There have been no serious reactions to the procedure during that time. Delaney et al2 cite experience at the University of Virginia, Charlottesville
Abram SE. Perceived Dangers From Intraspinal Steroid Injections. Arch Neurol. 1989;46(7):719–720. doi:10.1001/archneur.1989.00520430013005
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