Following his UFC 125 win and a failed drug test due to a "urine adulterant," Thiago Silva fessed up and admitted to breaking the Nevada State Athletic Commission's rules.

According to Silva, he opted to take injections of banned substances into his injured back and spine so he didn't have to pull out of the fight.

But if true, MMAjunkie.com medical columnist Dr. Johnny Benjamin – a fellowship-trained spine surgeon – said such procedures could have had fatal consequences.


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"I reinjured my back 45 days before the fight with Brandon Vera. After not fighting for a year, I made the decision to not pull out of the fight. I also decided that the only way I could continue with the fight was to take injections in my back and spine that contained substances prohibited by the Nevada (State) Athletic Commission. I also made the decision to use a product to hide the presence of these substances in a urine test." – Thiago Silva to MMAjunkie.com

As a fellowship-trained spine surgeon, I know a thing or two about back injuries and the treatment options. I appreciate Thiago Silva publicly accepting his mistake and attempting to move forward on a more honorable path.

But his statements are very interesting to me.

Epidural steroid injections (ESIs) are a very common and very legal treatment for certain back injuries. With the use of X-ray guidance, a specially trained physician carefully injects a combination of corticosteroid (not a prohibited substance vs. anabolic steroids, which are prohibited) and a short-acting anesthetic (lidocaine) into the spinal canal, specifically the epidural space.

The idea is to treat the inflamed nerve root with the proper medication in hopes of significantly relieving leg (sciatica) and back pain. In the proper hands – in properly selected patients and in a proper setting with the proper equipment – ESIs are very safe and effective.

So the questions that come to my medically trained mind are:

•What banned substances were injected into his "back and spine" prior his UFC 125 win over Brandon Vera?
•What specialty of physician performed the procedure?
•In what setting and with what equipment?
•Does Silva have any idea of the risks he took with his life if he had an anabolic steroid, HGH or some other banned substance injected into his spinal canal?
FYI: There is no medically accepted, evidence-based literature supporting the injection of anabolic steroids or HGH into the epidural space (spinal canal). In the U.S., to do so clearly would be considered rampant malpractice.

A potential infection in the spinal canal from an injection gone wrong can cause an epidural abscess or meningitis. Bacterial meningitis is often fatal (if not merely crippling), brain damaging and/or permanently life-altering. A mishap with the injection due to improper training (and I question the training and integrity of any doctor that may have done this) or equipment is fraught with devastating consequences.

Also, anabolic steroids and HGH are packaged with preservatives that allow a vial to hold multiple injections. These preservatives should not be injected into the spine because they can permanently damage nerve roots. (That's the reason it takes 14 years to become a spine surgeon; there's a lot of stuff to learn.)

I pray that Silva's official statement is his well-worded (and in his mind, excusable) explanation for just regular, garden-variety cheating (i.e. "I got caught attempting to mask my injection of anabolic steroids and/or HGH into my butt trying to help heal or recover from a training injury").

If, in fact, my suspicions/concerns are warranted, state athletic commissions, WADA, USADA, the UFC and especially fighters need to be very, very alarmed. A disaster is looming.