Dangers of Spinal Injections Without Proper Diagnosis

A RECENT EDITORIAL has wisely emphasized the advisability that a qualified neurological surgeon perform intraspinal surgery.¹ Of equal importance is a proper diagnosis when surgery is undertaken. There is a growing tendency toward relatively blind injection therapy, often done without standard diagnostic tests.^2-5 Recent problems in patients who have undergone such therapy prompt this report.

We have encountered a large intradural extramedullary vascular lesion, grossly having the appearance of pseudoaneurysm, but pathologically shown to be an invasive hemangioendothelioma. This patient had had a chymopapain injection for presumed cervical disk disease at the same level two months earlier at another hospital. While we do not suggest a direct causal relationship between the tumor and previous chymopapain injection for presumed disk rupture, it is important to emphasize the necessity for thorough diagnostic studies before treatment. A second patient had epidural injections of steroids for sciatic pain without significant pretherapy study.