Further Warnings From Australia Concerning Intraspinal Steroids

Dewey A. Nelson, MD

Arch Neurol. 1991;48(3):259-259. doi:10.1001/archneur.1991.00530150027009

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To the Editor. —There have been numerous warnings in various medical journals concerning the therapeutic use of methylprednisolone acetate (Depo-Medrol, Upjohn, Kalamazoo, Mich) by intraspinal injection.^1-19 Goldstein et al¹ were the first to publish complications in 1970. There followed reports of additional complications by Nelson et al,^2-6 Bernat et al,⁷ Nelson,^8-10 Roche,¹¹ Sekel,¹² Kepes and Duncalf,¹³ and Nelson.^14-19 Bernat et al⁷ demonstrated how this steroid compound entered the subdural space, then formed a "second sac," following which it migrated intracranially. Though the intrathecal use of methylprednisolone acetate virtually terminated by 1980,¹⁴ the epidural use by anesthesiologists in pain clinics gave rise to even more controversy than did its intrathecal therapy.^11-19 Two studies from Australia described 82% to 100% roentgenographically proved arachnoiditis (even from single injections) that resulted from intrathecal use,¹¹ as well as sterile meningitis, pachymeningitis with

REFERENCES

ABSTRACT | REFERENCES

Goldstein NP, McKenzie BF, McGuckim WF, Mattox VR. Experimental intrathecal administration of methylprednisolone acetate in multiple sclerosis . Trans Am Neurol Assoc . 1970;;95:243-244.

Nelson DA, Vates TS. Thomas RB. Complications from intrathecal steroids in the treatment of multiple sclerosis. By invitation, presented before National Advisory Board, National Multiple Sclerosis Society, New York, NY, December 5, 1971.

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Nelson DA. Presentation by Bernat JL, Sadowsky CH, Vincent FM, Nordgren RE, Margolis G. Sclerosing spinal pachymeningitis associated with intrathecal methylprednisolone acetate administration for multiple sclerosis (Discussion by Invitation), American Academy of Neurology 28th Annual Meeting, Toronto, Ontario, April 29, 1976.

Bernat JL, Sadowsky CH, Vincent FM, Nordgren RE, Margolis G. A complication of intrathecal administration of Depo-Medrol for multiple sclerosis . J Neurol Neurosurg Psychiatry . 1976;;39:1124-1128.

Nelson DA. Depo-Medrol Intrathecally. Guest Lecturer. Meeting of All Members of the Medical Staff and House Staff. Episcopal Hospital, Philadelphia, Pa, February 17, 1977.

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Roche J. Steroid-induced arachnoiditis . Med J Aust . 1984;;140:281-284.

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Kepes ER, Duncalf D. Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids: review . Pain . 1985;;22:33-47.

Nelson DA. Dangers from methylprednisolone acetate therapy by intraspinal injection . Arch Neurol . 1988;;45:805-806.

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