Epidural dexamethasone-21-palmitate for spinal stenosis-related pain: a retrospective cohort study using patient-reported outcome data.

Abstract

Objective: Epidural steroid infiltration has been used for decades as symptomatic pain therapy. To record and evaluate treatment response to epidural steroid infiltration, patient-reported outcome data were collected from patients receiving interlaminar or transforaminal epidural steroid infiltration with dexamethasone-21-palmitate (Lipotalon®).

Methods: This retrospective study included patient-reported outcome data from 212 patients who received treatment with translaminar or transforaminal epidural steroid infiltration at University Hospital Basel between July 2019 and April 2022. To evaluate pain and quality of life after treatment, the Numeric Rating Scale (NRS), Pain and Enjoyment of Life and General Activity (PEG) scale, European Quality of Life 5 Dimensions Questionnaire (EQ-5D-5L) and Oswestry Disability Index (ODI) were assessed prior to and at 7 days, one month and three months after treatment.

Results: There was a significant decrease in back pain on the NRS at 7 days and 3 months post-intervention compared to admission: 6.07 (SD 2.27) at admission, 4.52 (SD 2.26) at 7 days and 4.21 (SD 2.69) at 3 months (all p-values <0.001). Similarly, a significant decrease could be reported for leg pain: 5.59 (SD 2.72) at admission, 3.89 (SD 2.64) at 7 days and 3.58 (SD 2.84) at 3 months (all p-values <0.001). The mean PEG scale was 6.34 (SD 1.84) at admission, 4.52 (SD 2.15) at 7 days and 3.93 (SD 2.6) at 3 months (all p-values <0.001). The mean ODI score also improved significantly: 35.67 (SD 15.75) at admission, 28.24 (SD 16.11) at 7 days and 25.17 (SD 16.22) at 3 months (all p-values <0.002). The mean EQ-5D-5L score did not differ significantly during the observation period.

Conclusions: Dexamethasone-21-palmitate may be a potential treatment alternative to traditional water-soluble steroids. However, further controlled trials are necessary to confirm the efficacy and safety of this treatment.