—Dr Abram agreed that intrathecal therapy with methylprednisolone acetate carries risks; however, he believed that epidural injections are safe and that inadvertent subarachnoid injections are rare. The posterior interspinous ligaments are entered by inadvertency in a variable number of procedures, but not the 42.5% I quoted due to typographical error. The introducing of medications into ligaments is quoted by some authors at 25%,1 which is obviously not as serious as accidental spinal taps, which occur from 0.5% to 2.5%.1 These facts are more impressive when it is realized that methylprednisolone acetate administered by the intrathecal route gives rise to (radiographically proven) arachnoiditis in virtually 100% of patients.2Winnie et al3 originally recommended the use of methylprednisolone acetate epidurally, followed in 1978 by a report of meningitis and severe neurologic damage4. After Delaney et al5 studied the use of a similar steroid compound in cats
Nelson DA. Perceived Dangers From Intraspinal Steroid Injections-Reply. Arch Neurol. 1989;46(7):720–721. doi:10.1001/archneur.1989.00520430014006
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