Meralgia paresthetica: surgical management and outcome

Objectives To assess the outcomes of surgical management — decompression (neurolysis) or neurectomy — in patients with meralgia paresthetica refractory to conservative treatment, and to describe the indications guiding the choice between the two techniques. Background Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) clinically characterised by paraesthesia, numbness and burning pain over the anterolateral aspect of the thigh. It most commonly affects adults aged 30–40 years, although it can occur at any age. Methods In this retrospective cohort study, 11 consecutive patients who had failed at least three months of conservative treatment underwent surgery (neurolysis or neurectomy) and were followed for up to 12 months. The following data were collected: age, sex, body mass index (BMI), ultrasound, plain radiography, magnetic resonance imaging (MRI) of the lumbar spine, nerve conduction studies, duration of symptoms before intervention, and previously attempted conservative treatments. The pain visual analogue scale (VAS) and thigh numbness were recorded preoperatively and at the final postoperative follow-up visit. Results Eleven patients were operated on (7 male [64%], 4 female [36%]); the mean age was 39.3 years (range, 25–52). Nine patients (82%) had spontaneous (idiopathic) MP and two (18%) had iatrogenic MP following lumbar discectomy performed in the prone position. Neurolysis was performed in eight patients (73%) and neurectomy in three (27%). The mean VAS improved from 6.1 ± 0.8 (range, 5–7) preoperatively to 1.5 ± 1.0 (range, 0–3) at final follow-up (mean reduction 4.6 points; Wilcoxon signed-rank test, p < 0.001). Two patients (18%) achieved complete pain relief and nine (82%) reported satisfactory relief. Complications occurred in three patients (27%): hematoma in two (18%) and superficial wound infection in one (9%). The expected permanent anterolateral thigh numbness occurred in the three patients treated by neurectomy (27%). Conclusion In refractory MP, conservative measures remain first-line and surgery is reserved for failures. Neurolysis is recommended as the first surgical option because it preserves thigh sensation, whereas neurectomy is reserved for refractory or recurrent cases in which the patient accepts permanent numbness. In this small cohort both procedures achieved clinically meaningful pain relief; symptom recovery may continue for up to 12 months, particularly in idiopathic/metabolic cases. Larger comparative studies are required to define the optimal technique.