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October 1991

Epidural Steroids Are Safe and Effective When Given Appropriately

Arch Neurol. 1991;48(10):1012. doi:10.1001/archneur.1991.00530220028013

To the Editor.  —We read with interest Nelson's1 most recent attack on the use of intraspinal steroids. It appears that Nelson is continuing his relentless crusade to banish the use of epidural steroids, a crusade based, as usual, more on an emotional than on a scientific basis.Initially it appears that the 19 references in his letter to the editor1 would strongly support his viewpoint. However, on closer evaluation, one realizes that 14 of those 19 references are Nelson's articles, many of which are simply letters to the editor or lectures to others rehashing the same material.The majority of the references discounting the use of intraspinal steroids address the intrathecal use. In addition, most of the complications encountered by Nelson, or quoted by him, occurred in patients with another significant neurologic disease process, ie, multiple sclerosis. And, when Nelson refers to Bernat's article2 regarding a complication from