Introduction: Meralgia paresthetica causes pain, in the anterolateral thigh,
associated with dysesthesia and decreased sensation in the lateral
femoral cutaneous nerve (LFCN) territory. Surgery is offered when
conservative measures fail. Simple decompression is associated
with high failure rate. Neurectomy leaves the patient with an area
of loss of sensation in the thigh. A new technique of LFCN
transposition is described. Anatomical feasibility and early case
series are presented.
Methods: Three embalmed cadavers had the LFCN dissected in the upper
thigh and retroperitoneum. THE LFCN canal was opened and the
nerve mobilized medially. Nineteen cases of meralgia paresthetica
were surgically treated between 2011 and 2016. We had 3 groups:
simple decompression (S), deep decompression (D), and
transposition (T).
Results: In all cadavers, it was possible to mobilize the LFCN medially for
about 2 cm. Four patients underwent simple decompression, 5
deep decompression, and 10 transposition. The average
preoperative NRS for S was 7; 3.2 at 3 months postoperatively,
and 1 at 1 year (p = 0.0867). The average preoperative NRS for D
was 6.4; 1.6 at 3 months postoperatively, and 2.2 at 1 year (p =
0.0148). The average preoperative NRS for T was 6.5, 3 months
postoperatively 1.5 , and 1 year 1 (p < 0.0001). When comparing
the reduction in NRS between the three groups, the results were
not statistically significant. In the S group, 2 patients underwent
reoperation for nerve transection. In the D group, one patient was
reoperated for an infected hematoma. In the T group, no patient
underwent reoperation (p = 0.0454).
Conclusions: In most cases of meralgia paresthetica, the LFCN is too close to
the ASIS and needs to be mobilized medially. Transection should
not be the primary treatment, but saved for recurrences. Treating
nerve entrapment by cutting the nerve is counterintuitive and is
almost equivalent to euthanasia to treat cancer pain.
Patient Care: Neurectomy should not be the primary treatment for meralgia
paresthetica. Transposition has overwhelmingly good results and
should be the treatment of choice. It improves pain without the
disadvantage of losing sensation in the thigh.
Learning Objectives: 1. Technique of lateral femoral cutaneous nerve (LFCN)
transposition (newly defined by the author). 2. Avoid LFCN
transection except for recurrences.