Abstract
Background
Surgical treatment options for meralgia paresthetica include neurolysis and neurectomy procedures. Reported success rates for pain relief are generally higher after neurectomy, but an obvious disadvantage compared with neurolysis is the loss of sensation in the anterolateral part of the thigh. In this study we analyzed our results on pain relief after both procedures, and we determined the impact of loss of sensation with a questionnaire.
Methods
Between 1999 and 2009, all patients with persistent symptoms of meralgia paresthetica who presented to our clinic after failure of conservative treatment were offered a neurectomy procedure. After this period, the surgical strategy was changed to first neurolysis followed by neurectomy in case of failure. We retrospectively analyzed our results for both strategies with a questionnaire that was focused on pain relief, numbness and the impact of numbness.
Results
Ten patients underwent a neurolysis with a 60 % pain relief rate compared to 87.5 % of the eight patients that primarily underwent a neurectomy. Most neurectomy patients (62.5 %) were not hindered by the numbness, 25 % sometimes and only one patient was frequently bothered, but was still satisfied with the outcome. The failures of neurolysis were secondarily treated by neurectomy, which resulted in pain relief in three out of four patients.
Conclusions
This series confirms previous reports in the literature that have shown higher success rates for the neurectomy procedure. In addition, it shows that most patients are not bothered by the numbness following this procedure. These observations can be used in the surgical decision making for meralgia paresthetica.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alberti O, Wickboldt J, Becker R (2009) Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica. J Neurosurg 110:768–774
Aldrich EF, van den Heever CM (1989) Suprainguinal ligament approach for surgical treatment of meralgia paresthetica. Technical note. J Neurosurg 70:492–494
Antoniadis G, Braun V, Rath S, Moese G, Richter HP (1995) Meralgia paraesthetica and its surgical treatment. Nervenarzt 66:614–617
Ducic I, Dellon AL, Taylor NS (2006) Decompression of the lateral femoral cutaneous nerve in the treatment of meralgia paresthetica. J Reconstr Microsurg 22:113–118
Ecker A, Woltman HW (1938) Meralgia paresthetica: A report of one hundred and fifty cases. JAMA 110:1650
Edelson R, Stevens P (1994) Meralgia paresthetica in children. J Bone Joint Surg Am 76:993–999
Ghent WR (1961) Further studies on meralgia paresthetica. Can Med Assoc J 85:871–875
Keegan JJ, Holyoke EA (1962) Meralgia paresthetica. An anatomical and surgical study. J Neurosurg 19:341–345
Khalil N, Nicotra A, Rakowicz W (2008) Treatment for meralgia paraesthetica. Cochrane Database Syst Rev 3:CD004159
Kho KH, Blijham PJ, Zwarts MJ (2005) Meralgia paresthetica after strenuous exercise. Muscle Nerve 31:761–763
Macnicol MF, Thompson WJ (1990) Idiopathic meralgia paresthetica. Clin Orthop Relat Res 254:270–274
Nahabedian MY, Dellon AL (1995) Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg 35:590–594
Seror P, Seror R (2006) Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve 33:650–654
Siu TL, Chandran KN (2005) Neurolysis for meralgia paresthetica: an operative series of 45 cases. Surg Neurol 63:19–23, discussion 23
Stookey B (1928) Meralgia paresthetica. Etiology and surgical treatment. J Am Med Assoc 90:1705–1707
Teng P (1972) Meralgia paresthetica. Bull Los Angeles Neurol Soc 37:75–83
van Eerten PV, Polder TW, Broere CA (1995) Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery 37:63–65
van Slobbe AM, Bohnen AM, Bernsen RM, Koes BW, Bierma-Zeinstra SM (2004) Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol 251:294–297
Williams PH, Trzil KP (1991) Management of meralgia paresthetica. J Neurosurg 74:76–80
Acknowledgments
The authors thank the secretaries Sandra Annokkee and Jannie van Duijn for their help in gathering the medical records and sending out the questionnaires.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Appendix
Rights and permissions
About this article
Cite this article
de Ruiter, G.C.W., Wurzer, J.A.L. & Kloet, A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir 154, 1765–1772 (2012). https://doi.org/10.1007/s00701-012-1431-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-012-1431-0