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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(01): 013-019
DOI: 10.1055/s-0040-1715785
Original Article

Decompression and Neurolysis of the Lateral Femoral Cutaneous Nerve in the Surgical Treatment of Meralgia Paresthetica and the Results

Kenan Kıbıcı 
1   Department of Neurosurgery, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
,
Berrin Erok 
2   Department of Radiology, Cihanbeyli State Hospital, Konya, Turkey
,
Ali Önder Atca 
3   Department of Radiology, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
› Author Affiliations Funding None.
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Abstract

Meralgia paresthetica (MP), also known as Bernhardt–Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 ± 0.62 and the postoperative VAS value at the sixth month was 1.17 ± 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.

Keywords

meragia paresthetica - lateral femoral cutaneous nerve - decompression and neurolysis


Publication History

Article published online:
27 November 2020

© 2020. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Hager W. Neuralgia femoris. Resection des Nerv. cutan. femoris anterior externus. Heilung. Dtsch Med Wochenschr 1885; 11: 218-219
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Bernhardt M. Ueber Isolirt im Gebiete des N. cutaneous femoris externus vorkommende Parasthesien. Neurol Centrabl 1895; 14: 242-244
    PubMedGoogle Scholar
  • 3 Dias Filho LC, Valença MM, Guimarães Filho FA. et al. Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat 2003; 16 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 4 Lee SH, Shin KJ, Gil YC, Ha TJ, Koh KS, Song WC. Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica. Muscle Nerve 2017; 55 (05) 646-650
    CrossrefPubMedGoogle Scholar
  • 5 Natsis K, Paraskevas G, Tzika M, Papathanasiou E. Variable origin and ramification pattern of the lateral femoral cutaneous nerve: a case report and neurosurgical considerations. Turk Neurosurg 2013; 23 (06) 840-843
    PubMedGoogle Scholar
  • 6 Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat 2009; 22 (03) 365-370
    CrossrefPubMedGoogle Scholar
  • 7 Chhabra A, Del Grande F, Soldatos T. et al. Meralgia paresthetica: 3-Tesla magnetic resonance neurography. Skeletal Radiol 2013; 42 (06) 803-808
    CrossrefPubMedGoogle Scholar
  • 8 Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CF, Vieira RL, Zember JS. MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics 2010; 30 (04) 983-1000
    CrossrefPubMedGoogle Scholar
  • 9 Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (05) 336-344
    CrossrefPubMedGoogle Scholar
  • 10 Blake SM, Treble NJ. Meralgia paraesthetica–an addition to ‘seatbelt syndrome’. Ann R Coll Surg Engl 2004; 86 (06) W6-7
    CrossrefPubMedGoogle Scholar
  • 11 Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011; 77 (16) 1538-1542
    CrossrefPubMedGoogle Scholar
  • 12 Donovan A, Rosenberg ZS, Cavalcanti CF. MR imaging of entrapment neuropathies of the lower extremity. Part 2. The knee, leg, ankle, and foot. Radiographics 2010; 30 (04) 1001-1019
    CrossrefPubMedGoogle Scholar
  • 13 Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res 2010; 468 (09) 2397-2404
    CrossrefPubMedGoogle Scholar
  • 14 Gupta A, Muzumdar D, Ramani PS. Meralgia paraesthetica following lumbar spine surgery: a study in 110 consecutive surgically treated cases. Neurol India 2004; 52 (01) 64-66
    PubMedGoogle Scholar
  • 15 Yang SH, Wu CC, Chen PQ. Postoperative meralgia paresthetica after posterior spine surgery: incidence, risk factors and clinical outcomes. Spine 2005; 30: 47-50
    CrossrefPubMedGoogle Scholar
  • 16 Yamamoto T, Nagira K, Kurosaka M. Meralgia paresthetica occurring 40 years after iliac bone graft harvesting: case report. Neurosurgery 2001; 49 (06) 1455-1457
    CrossrefPubMedGoogle Scholar
  • 17 Peters G, Larner AJ. Meralgia paresthetica following gynecologic and obstetric surgery. Int J Gynaecol Obstet 2006; 95 (01) 42-43
    CrossrefPubMedGoogle Scholar
  • 18 Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 2013; 8 (06) 883-893
    PubMedGoogle Scholar
  • 19 Nouraei SA, Anand B, Spink G, O’Neill KS. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurgery 2007; 60 (04) 696-700, discussion 700
    CrossrefPubMedGoogle Scholar
  • 20 Parmar MS. Hiphuggers’ tingly thighs. AJ 2003; 168 (01) 16
    PubMedGoogle Scholar
  • 21 Aras B, Adiguzel E, Tok F. Lateral femoral cutaneous nerve blockage. TurkJ Neurol 2019; 25: 54-57
    CrossrefPubMedGoogle Scholar
  • 22 Haim A, Pritsch T, Ben-Galim P, Dekel S. Meralgia paresthetica: A retrospective analysis of 79 patients evaluated and treated according to a standard algorithm. Acta Orthop 2006; 77 (03) 482-486
    CrossrefPubMedGoogle Scholar
  • 23 de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien) 2012; 154 (10) 1765-1772
    CrossrefPubMedGoogle Scholar
  • 24 Payne R, Seaman S, Sieg E, Langan S, Harbaugh K, Rizk E. Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica?. Acta Neurochir (Wien) 2017; 159 (05) 931-936
    CrossrefPubMedGoogle Scholar
  • 25 de Ruiter GC, Kloet A. Comparison of effectiveness of different surgical treatments for meralgia paresthetica: Results of a prospective observational study and protocol for a randomized controlled trial. Clin Neurol Neurosurg 2015; 134: 7-11
    CrossrefPubMedGoogle Scholar
  • 26 Emamhadi M. Surgery for meralgia paresthetica: neurolysis versus nerve resection. Turk Neurosurg 2012; 22 (06) 758-762
    PubMedGoogle Scholar
  • 27 Holanda MM, Meira UM, Magalhaes FN, da Silva JA. Surgical treatment of meralgia paresthetica: a case report. Arq Neuropsiquiatr 2003; 18: 132-135
    PubMedGoogle Scholar
  • 28 Ataizi ZS, Ertilav K, Ercan S. Surgical options for meralgia paresthetica: long-term outcomes in 13 cases. Br J Neurosurg 2019; 33 (02) 188-191
    CrossrefPubMedGoogle Scholar
  • 29 van Eerten PV, Polder TW, Broere CA. Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery 1995; 37 (01) 63-65
    CrossrefPubMedGoogle Scholar
  • 30 Ducic I, Dellon AL, Taylor NS. Decompression of the lateral femoral cutaneous nerve in the treatment of meralgia paresthetica. J Reconstr Microsurg 2006; 22 (02) 113-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg 1995; 35 (06) 590-594
    CrossrefPubMedGoogle Scholar
  • 32 Siu TL, Chandran KN. Neurolysis for meralgia paresthetica: an operative series of 45 cases. Surg Neurol 2005; 63 (01) 19-23, discussion 23
    CrossrefPubMedGoogle Scholar
  • 33 Schwaiger K, Panzenbeck P, Purschke M. et al. Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine (Baltimore) 2018; 97 (33) e11914
    CrossrefPubMedGoogle Scholar