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Rowley E, Suresh R, de Rutier AG, Dellon L, Tollestrup TW. Clinical Insights and Optimization of Surgical Approach for Lateral Femoral Cutaneous Nerve Injury/Entrapment: A Comprehensive Analysis of 184 Cases. Ann Plast Surg 2024:00000637-990000000-00480. [PMID: 38896846 DOI: 10.1097/sap.0000000000003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Entrapment or injury of the lateral femoral cutaneous nerve (LFCN) is being recognized with increasing frequency, often requiring a surgical approach to relieve symptoms. The presence of anatomic variations can lead to errors in diagnosis and intraoperative decision-making. METHODS This study presents the experience of a single surgeon (T.W.T.) in managing 184 patients referred with clinical issues related to the LFCN. A comprehensive review of these cases was conducted to develop a prospective surgical management algorithm. Data on the LFCN's anatomic course, pain relief outcomes, comorbidities, body mass index, and sex were extracted from patients' medical charts and operative notes. Pain relief was assessed subjectively, categorized into "excellent relief" for complete pain resolution, "good" for substantial pain reduction with some residual discomfort, and "failure" for cases with no pain relief necessitating reoperation. RESULTS The decision tree is dichotomized based on the mechanism of LFCN pathology: compression (requiring neurolysis) versus history of trauma, surgery, and/or obesity (requiring resection). Forty-seven percent of the patients in this series had an anatomic variation. It was found that failure to relieve symptoms of compression often indicated the presence of anatomic variation of the LFCN or intraneural changes consistent with a neuroma, even if adequate decompression was achieved. With respect to pain relief as the outcome measure, recognition of LFCN anatomic variability and use of this algorithm resulted in 75% excellent results, 10% good results, and 15% failures. Twenty-seven of the 36 failures originally had neurolysis as the surgical approach. Twelve of those failures had a second surgery, an LFCN neurectomy, resulting in 10 excellent, 1 good, and 1 persistent failure. CONCLUSION This article establishes an algorithm for the surgical treatment of MP, incorporating clinical experience and anatomical insights to guide treatment decisions. Criteria for considering neurectomy may include a history of trauma, prior local surgery, anatomical LFCN variations, and severe nerve damage due to chronic compression.
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Affiliation(s)
| | - Rachana Suresh
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - A Godard de Rutier
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
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Almasi J, Ambrus R, Steno B. Meralgia Paresthetica-An Approach Specific Neurological Complication in Patients Undergoing DAA Total Hip Replacement: Anatomical and Clinical Considerations. Life (Basel) 2024; 14:151. [PMID: 38276280 PMCID: PMC10817486 DOI: 10.3390/life14010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Introduction: Mini-invasive surgical (MIS) approaches to total hip replacement (THR) are becoming more popular and increasingly adapted into practice. THR via the direct anterior approach (MIS DAA) has become a rather controversial topic in hip arthroplasty literature in the last decades. Our retrospective observational study focuses on the prevalence of one approach-specific complication-lateral femoral cutaneous nerve (LFCN) iatrogenic lesion-and tries to clarify the possible pathogenesis of this injury. Methods: This is a retrospective single-cohort observational single-center and single-surgeon study. Our patient records were searched for the period from 2015 to 2017-after a safe period of time after the learning curve for MIS DAA. All intra- and post-operative lesions of the LFCN were recorded. Lesion of the LFCN was confirmed by a neurological examination. Minimum patient follow-up was 2 years. Results: This study involved 417 patients undergoing single-side THR via MIS DAA. Patients were examined on follow-up visits at 6 weeks, 6 months, 1 year, and 2 years after surgery. There were 17 cases of LCFN injury at the 6 weeks early follow-up visit (4.1%). All cases of clinically presenting LFCN injury resolved at the 2-year follow-up ad integrum. Discussion: Possible explanations of such neurological complications are direct iatrogenic injury, vigorous traction, hyperextension, or extreme external rotation of the operated limb. Use of a traction table or concomitant spinal pathology and deformity also play a role. Prevention involves stepwise adaptation of the approach during the learning curve period by attending cadaver lab courses, rational use of traction and hyperextension, and careful surgical technique in the superficial and deep fascial layers. Dynamometers could be used to visualise the limits of manipulation of the operated limb. Conclusions: Neurological complications are not as rare but questionably significant in patients undergoing THR via the DAA. Incidental finding of LFCN injury has no effect on the functional outcome of the artificial joint. It can lead to lower subjective satisfaction of patients with the operation, which can be avoided with careful education and management of expectations of the patients.
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Affiliation(s)
- Jozef Almasi
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Richard Ambrus
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Boris Steno
- II. University Department of Orthopaedic and Trauma Surgery, University Hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Antolska 11, Petrzalka, 851 01 Bratislava, Slovakia;
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3
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Umansky D, Elzinga K, Midha R. Surgery for mononeuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:227-249. [PMID: 38697743 DOI: 10.1016/b978-0-323-90108-6.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Advancement in microsurgical techniques and innovative approaches including greater use of nerve and tendon transfers have resulted in better peripheral nerve injury (PNI) surgical outcomes. Clinical evaluation of the patient and their injury factors along with a shift toward earlier time frame for intervention remain key. A better understanding of the pathophysiology and biology involved in PNI and specifically mononeuropathies along with advances in ultrasound and magnetic resonance imaging allow us, nowadays, to provide our patients with a logical and sophisticated approach. While functional outcomes are constantly being refined through different surgical techniques, basic scientific concepts are being advanced and translated to clinical practice on a continuous basis. Finally, a combination of nerve transfers and technological advances in nerve/brain and machine interfaces are expanding the scope of nerve surgery to help patients with amputations, spinal cord, and brain lesions.
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Affiliation(s)
- Daniel Umansky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Kate Elzinga
- Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Scholz C, Hohenhaus M, Pedro MT, Uerschels AK, Dengler NF. Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:655-661. [PMID: 37534445 PMCID: PMC10622057 DOI: 10.3238/arztebl.m2023.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Pain and sensory disturbance in the distribution of the lateral femoral cutaneous nerve in the ventrolateral portion of the thigh is called meralgia paresthetica (MP). The incidence of MP has risen along with the increasing prevalence of obesity and diabetes mellitus and was recently estimated at 32 new cases per 100 000 persons per year. In this review, we provide an overview of current standards and developments in the diagnosis and treatment of MP. METHODS This review is based on publications retrieved by a selective literature search, with special attention to meta-analyses, systematic reviews, randomized and controlled trials (RCTs), and prospective observational studies. RESULTS The diagnosis is mainly based on typical symptoms combined with a positive response to an infiltration procedure. In atypical cases, electrophysiological testing, neurosonography, and magnetic resonance imaging can be helpful in establishing the diagnosis. The literature search did not reveal any studies of high quality. Four prospective observational studies with small case numbers and partly inconsistent results are available. In a meta-analysis of 149 cases, pain relief was described after infiltration in 85% of cases and after surgery in 80%, with 1-38 months of follow-up. In another meta-analysis of 670 cases, there was pain relief after infiltration in 22% of cases, after surgical decompression in 63%, and after neurectomy in 85%. Hardly any data are available on more recent treatment options, such as radiofrequency therapy, spinal cord stimulation, or peripheral nerve stimulation. CONCLUSION The state of the evidence is limited in both quantity and quality, corresponding to evidence level 2a for surgical and non-surgical methods. Advances in imaging and neurophysiological testing have made the diagnosis easier to establish. When intervention is needed, good success rates have been achieved with surgery (decompression, neurectomy), and variable success rates with infiltration.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Marc Hohenhaus
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Maria T. Pedro
- Department of Neurosurgery, Peripheral Nerves Section, University of Ulm at Günzburg District Hospital
| | | | - Nora F. Dengler
- Department of Neurosurgery, Charité–University Medical Center Berlin
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Nonnenmacher L, Zimmerer A, Hofer A, Bohorc M, Matziolis G, Wassilew G. [Complication management after periacetabular osteotomy]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:272-281. [PMID: 36939881 PMCID: PMC10063494 DOI: 10.1007/s00132-023-04359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Hip dysplasia is the most common cause of secondary hip osteoarthritis. The Ganz periacetabular osteotomy (PAO) is a well-established procedure that allows a reliable and reproducible correction of the complex pathology. The promising medium and long-term good treatment results are offset by the potential risk of complications from an invasive pelvic procedure. Considering the mainly young age of the patients, knowledge of the possible complications and the resulting adequate therapy is crucial. TREATMENT DEVELOPMENT The continuous development of surgical techniques and increase in overall surgical experience alongside the appreciation of critical surgical steps have led to a substantial reduction of serious complications. In addition, to improve patient outcome, a greater understanding of the associated pathologies that may be related to hip dysplasia is essential.
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Affiliation(s)
- Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Alexander Zimmerer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - André Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Manuela Bohorc
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Georg Matziolis
- Deutsches Zentrum für Orthopädie, Waldkliniken Eisenberg, 07607, Eisenberg, Deutschland
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland.
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Gomez YDLC, Remotti E, Momah DU, Zhang E, Swanson DD, Kim R, Urits I, Kaye AD, Robinson CL. Meralgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment. Health Psychol Res 2023; 11:71454. [PMID: 36937080 PMCID: PMC10019995 DOI: 10.52965/001c.71454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Purpose of Review Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options. Recent Findings Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that's universally effective for treating all patients with MP. Summary Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants.
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Affiliation(s)
| | - Edgar Remotti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Deandra Uju Momah
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Emily Zhang
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Daniel D Swanson
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Aureli V, Vat M, Hankov N, Théaudin M, Ravier J, Becce F, Demesmaeker R, Asboth L, Courtine G, Bloch J. Targeted dorsal root entry zone stimulation alleviates pain due to meralgia paresthetica. J Neural Eng 2022; 19. [PMID: 36541540 DOI: 10.1088/1741-2552/aca5f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
Objective.Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain.Approach.A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments.Main results.Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities.Significance.We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort.
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Affiliation(s)
- Viviana Aureli
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Molywan Vat
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Nicolas Hankov
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Marie Théaudin
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jimmy Ravier
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Robin Demesmaeker
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Leonie Asboth
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Grégoire Courtine
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
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Solomons JNT, Sagir A, Yazdi C. Meralgia Paresthetica. Curr Pain Headache Rep 2022; 26:525-531. [PMID: 35622311 DOI: 10.1007/s11916-022-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This review article summaries the epidemiology, etiology, clinical presentations, and latest treatment modalities of meralgia paresthetica, including the latest data about peripheral and spinal cord stimulation therapy. Meralgia paresthetica (MP) causes burning, stinging, or numbness in the anterolateral part of the thigh, usually due to compression of the lateral femoral cutaneous nerve (LFCN). RECENT FINDINGS There are emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, and other interventions including spinal cord and peripheral nerve stimulation reserved for refractory cases. The strength of evidence for treatment choices in meralgia paraesthetica is weak. Some observational studies are comparing local injection of corticosteroid versus surgical interventions. However, more extensive studies are needed regarding the long-term benefit of peripheral and spinal cord stimulation therapy.
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Affiliation(s)
| | - Afrin Sagir
- Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Brookline, MA, USA.
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Jack MM, Smith BW, Spinner RJ. Neurosurgery for the Neurologist: Peripheral Nerve Injury and Compression (What can be Fixed?). Neurol Clin 2022; 40:283-295. [DOI: 10.1016/j.ncl.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Dalal S, Berger AA, Orhurhu V, Kaye AD, Hasoon J. Peripheral Nerve Stimulation for the Treatment of Meralgia Paresthetica. Orthop Rev (Pavia) 2021; 13:24437. [PMID: 34745464 DOI: 10.52965/001c.24437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022] Open
Abstract
Meralgia paresthetica is a condition caused by entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. This nerve is a purely sensory nerve and provides innervation to the anterolateral portion of the thigh. The condition can lead to numbness, paresthesia, dysesthesia, and pain over the anterolateral aspect of the thigh, which are exacerbated with walking, standing, and hip extension. First-line treatment for MP includes conservative measures such as weight loss and eliminating tight-fitted clothing. Neuropathic pain medications and corticosteroid injections are also treatment options for some patients with significant pain complaints. In more refractory cases, surgical intervention can be considered. Peripheral nerve stimulation has also been shown to be a helpful treatment modality for patients with refractory meralgia paresthetica. Here we report our experience utilizing peripheral nerve stimulation in patients with significant pain complaints related to refractory meralgia paresthetica.
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Affiliation(s)
- Suhani Dalal
- A.T. Still University School of Medicine, Mesa, AZ
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Vwaire Orhurhu
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Alan D Kaye
- Louisiana State University Health Sciences Center, Shreveport, LA
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA; Pain Specialists of America, Austin, TX
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[Decompression of the lateral femoral cutaneous nerve of the thigh : Treatment of meralgia paresthetica]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 34:90-97. [PMID: 34739548 DOI: 10.1007/s00064-021-00747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Treatment of non-responding pain to conservative treatment located at the anterolateral thigh with surgical decompression of the lateral femoral cutaneous nerve of the thigh (LFCN). INDICATIONS Compression syndrome of the LFCN; patients suffering from the following symptoms: pain (dysesthesia), numbness (paresthesia), hypersensibility to temperature (or temperature changes) along the course of the LFCN located at the anterolateral thigh. CONTRAINDICATIONS A new or recrudescent hernia with additional pain or recent laparoscopic hernia repair as a supposed iatrogenically induced compression of the LFCN. SURGICAL TECHNIQUE Dissection and release of the LFCN of connective tissue, scar tissue, bone rims, and retraction located along the passage underneath the inguinal ligament and distally. POSTOPERATIVE MANAGEMENT Suture removal after 10-14 days, no sports for 2 weeks. Physiotherapy if necessary. Neurography 4 months after surgery (obligatory if symptoms are persistent). The patient should be followed up for about 24 months. RESULTS Of the patients, 69% had a history of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses and 22% had previous falls. Postoperatively, a significant reduction of pain of 6.6 points on the numeric rating scale was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.
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12
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Kesserwani H. Meralgia Paresthetica: A Case Report With an Update on Anatomy, Pathology, and Therapy. Cureus 2021; 13:e13937. [PMID: 33880277 PMCID: PMC8051538 DOI: 10.7759/cureus.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Meralgia paresthetica, a condition characterized by tingling, numbness, and burning pain in the lateral aspect of the thigh, is caused by compression of the lateral femoral cutaneous nerve. The incidence of meralgia paresthetica increases with obesity and diabetes. The unique anatomy of the nerve that tunnels through the inguinal ligament predisposes it to inflammation, trauma, and entrapment. The pathology of meralgia paresthetica parallels that of entrapment neuropathies but with additional inflammatory overlay in certain instances. The clinical diagnosis is relatively simple due to its unique clinical features. The prognosis is generally excellent, and the treatment is straightforward that includes peripheral nerve blocks, neurectomy, nerve decompression, and pulsed radiofrequency neuromodulation. This current case of meralgia paresthetica highlights the salient clinical symptoms and signs. We have also described the electrophysiological studies of the lateral femoral cutaneous nerve, its anatomical variations, and the associations of meralgia paresthetica with bariatric surgery, critical care patients, tight clothing, pregnancy, and posterior spine surgery. We have also outlined the current treatment strategies.
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13
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Langford B, Mauck WD. Peripheral Nerve Stimulation: A New Treatment for Meralgia Paresthetica. PAIN MEDICINE 2021; 22:213-216. [PMID: 33164097 DOI: 10.1093/pm/pnaa326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Meralgia paresthetica is a condition caused by entrapment of the lateral femoral cutaneous nerve that leads to paresthesia along the anterolateral portion of the thigh. Because of advancements in neuromodulation, peripheral nerve stimulation (PNS) has been considered a new treatment option for meralgia paresthetica. Newer PNS technology targets peripheral nerves directly yet in a minimally invasive manner. We report a case in which a PNS device provided more than 12 months of complete pain relief in a patient with meralgia paresthetica and helped the patient avoid a neurolysis procedure. CASE PRESENTATION A 57-year-old male presented to clinic with a 6-year history of "painful numbness [and] burning" along the right lateral thigh. He rated his pain as 8 out of 10, which decreased to a rating of 2 out of 10 with the use of gabapentin, but unwanted side effects motivated him to seek alternative treatment. On the basis of his history, physical exam, and imaging results, he was diagnosed with meralgia paresthetica. He was offered neurolysis; however, after seeing a pain specialist, he agreed to the implantation of a SPRINT peripheral nerve stimulator. After the implantation procedure, his pain reduced to 0 out of 10, and his quality of life improved, with better sleep and less somnolence. The device was removed after 60 days, as planned. He continued to have complete resolution of pain at 12 months after the date of device implantation. CONCLUSION With recent advancements, PNS can be used to treat meralgia paresthetica in an effective yet minimally invasive manner. As newer PNS technology becomes more familiar to physicians and pain specialists, it is likely to be used as a mainstay treatment for meralgia paresthetica.
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Affiliation(s)
- Brendan Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William D Mauck
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lu VM, Burks SS, Heath RN, Wolde T, Spinner RJ, Levi AD. Meralgia paresthetica treated by injection, decompression, and neurectomy: a systematic review and meta-analysis of pain and operative outcomes. J Neurosurg 2021; 135:912-922. [PMID: 33450741 DOI: 10.3171/2020.7.jns202191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve (LFCN) and often presents with pain. Multiple treatment options targeting the LFCN can be pursued to treat the pain should conservative measures fail, with the most common options being injection, neurolysis, and neurectomy. However, their efficacy in causing pain relief and their clinical outcomes have yet to be directly compared. The aim of this study was to interrogate the contemporary literature and quantitatively define how these options compare. METHODS The electronic databases Ovid Embase, PubMed, SCOPUS, and the Cochrane Library were interrogated from inception to May 2020 following the PRISMA guidelines. Candidate articles were screened against prespecified criteria. Outcome data were abstracted and pooled by random-effects meta-analysis of proportions. RESULTS There were 25 articles that satisfied all criteria, reporting outcomes for a total of 670 meralgia paresthetica patients, with 78 (12%) treated by injection, 496 (74%) by neurolysis, and 96 (14%) by neurectomy. The incidence of complete pain relief was 85% (95% CI 71%-96%) after neurectomy, 63% (95% CI 56%-71%) after neurolysis, and 22% (95% CI 13%-33%) after injection, which were all statistically different (p < 0.01). The incidence of revision procedures was 12% (95% CI 4%-22%) after neurolysis and 0% (95% CI 0%-2%) after neurectomy, which were significantly lower than 81% (95% CI 64%-94%) after injection (p < 0.01). The incidences of treatment complications were statistically comparable across all three treatments, ranging from 0% to 5% (p = 0.34). CONCLUSIONS There are multiple treatment options to target pain in meralgia paresthetica. The incidence of complete pain relief appears to be the greatest among the 3 interventions after neurectomy, accompanied by the lowest incidence of revision procedures. These findings should help inform patient preference and expectations. Greater exploration of the anatomical rationale for incomplete pain relief after surgical intervention will assist in optimizing further surgical treatment for meralgia paresthetica.
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Affiliation(s)
- Victor M Lu
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - S Shelby Burks
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Rainya N Heath
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Tizeta Wolde
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Robert J Spinner
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allan D Levi
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
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Kıbıcı K, Erok B, Atca AÖ. Decompression and Neurolysis of the Lateral Femoral Cutaneous Nerve in the Surgical Treatment of Meralgia Paresthetica and the Results. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1715785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractMeralgia 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.
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Affiliation(s)
- Kenan Kıbıcı
- Department of Neurosurgery, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
| | - Berrin Erok
- Department of Radiology, Cihanbeyli State Hospital, Konya, Turkey
| | - Ali Önder Atca
- Department of Radiology, Altınbas University School of Medicine Bahcelievler Medical Park Hospital, İstanbul, Turkey
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McNutt S, Hallan DR, Rizk E. Evaluating the Evidence: Is Neurolysis or Neurectomy a Better Treatment for Occipital Neuralgia? Cureus 2020; 12:e11461. [PMID: 33329959 PMCID: PMC7733770 DOI: 10.7759/cureus.11461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Occipital neuralgia, a neuropathy of the occipital nerves, can cause significant pain and distress, resulting in a decrease in the patient's quality of life. Options for surgical treatment involve transection or decompression of the greater and lesser occipital nerves. Current evidence provides no clear consensus regarding one technique over the other. Here, we present a systematic review of the literature to potentially answer this question. Eligible studies compared neurolysis versus neurectomy for the treatment of occipital neuralgia after failure of conservative therapy. Our outcome of interest was resolution of symptoms. We performed a search of MEDLINE/PubMed and Ovid from inception to 2019. Eligible studies included the words "occipital neuralgia" and "surgery." All studies comparing neurolysis to neurectomy were included in the analysis. None of the studies identified were randomized control trials. Each study was evaluated by two independent researchers who assigned a level of evidence according to the American Association of Neurology (AAN) algorithm. Data extracted included mechanism of surgery (neurolysis or neurectomy), resolution of pain symptoms, and length of follow-up. Each study was level IV evidence. After reviewing the data, there was insufficient evidence to recommend one method of treatment over the other. This inconclusive result highlights the importance of a national registry to compare outcomes between the two treatment modalities.
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Affiliation(s)
- Sarah McNutt
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - David R Hallan
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol 2020; 36:450-457. [PMID: 33840922 PMCID: PMC8022067 DOI: 10.4103/joacp.joacp_170_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022] Open
Abstract
Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic-based multimodal therapy targeting the pain pathway. This narrative review will describe relevant anatomy, causes, assessment, investigation, and management of chronic hip pain. The focus will be on current evidence-based management of hip osteoarthritis, greater trochanteric pain syndrome, meralgia paresthetica, and piriformis syndrome. Recently, there is emphasis on the role of ultrasound in interventional pain procedures. The use of fluoroscopic-guided radiofrequency in periarticular branches of hip joint has reported to provide pain relief of up to 36 months. However, the current evidence for use of platelet-rich plasma in chronic hip osteoarthritis pain is inconclusive. Further research is required in the management of chronic hip pain regarding comparison of fluoroscopic- and ultrasound-guided procedures, role of platelet-rich plasma, and radiofrequency procedures with long-term follow-up of patients.
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Affiliation(s)
- Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sofia Patial
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Anjuman Chander
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Anupam Ahuja
- Consultant Orthopaedics, Orthomax Hospital, Panchkula, Haryana, India
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Laparoscopic-Assisted Intra-Abdominal Section of the Lateral Femoral Cutaneous Nerve for Meralgia Paresthetica Following Anterior Hip Arthroplasty. World Neurosurg 2019; 126:415-417. [PMID: 30898736 DOI: 10.1016/j.wneu.2019.03.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meralgia paresthetica, a pain syndrome that is caused by injury to the lateral femoral cutaneous nerve, is a well-documented complication after anterior hip arthroplasty (THA). Traditional treatment of this peripheral nerve entrapment syndrome can be complicated in patients who have had THA via an anterior approach owing to the presence of scar in the postoperative bed. CASE DESCRIPTION In a 70-year-old man, we performed a novel laparoscopic-assisted intra-abdominal approach to treat meralgia paresthetica in the setting of previous anterior THA. CONCLUSIONS Minimally invasive intra-abdominal treatment of meralgia paresthetica following anterior THA results in durable pain relief. This approach is a helpful alternative to traditional techniques of decompression or section of the lateral femoral cutaneous nerve below the inguinal ligament.
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de Ruiter GCW, Lim J, Thomassen BJW, van Duinen SG. Histopathologic changes inside the lateral femoral cutaneous nerve obtained from patients with persistent symptoms of meralgia paresthetica. Acta Neurochir (Wien) 2019; 161:263-269. [PMID: 30560377 DOI: 10.1007/s00701-018-3773-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with persistent symptoms of meralgia paresthetica, a neurectomy of the lateral femoral cutaneous nerve (LFCN) can be performed to alleviate pain symptoms. The neurectomy procedure can be performed either as a primary procedure or after failure of a previously performed neurolysis or decompression of the LFNC (secondary neurectomy). The goal of the present study was to quantify the histopathologic changes inside the LFCN obtained from patients with persistent symptoms of meralgia paresthetica, and specifically to compare to what extend these changes are present after primary versus secondary neurectomy. METHODS A total of 39 consecutive cases were analyzed microscopically: in 29 cases, the neurectomy had been performed as primary procedure, in 10 cases, after failed neurolysis. Intraneural changes were quantified for the (1) thickening of perineurium, (2) deposition of mucoid, and (3) percentage of collagen. Analysis was performed at three levels: proximal to, at, and distal to the previous site of compression. In addition, correlations were investigated for the duration of symptoms and the body mass index (BMI) of the patient. RESULTS Intraneural changes were found consistently in all cases. There was no significant difference for the primary and secondary neurectomy groups. There was also no relation with the previous site of compression. There was a weak correlation between the occurrence of intraneural changes and the duration of symptoms, although this difference was not statistically significant. CONCLUSIONS Histopathological changes in this study were found in all patients with persistent symptoms of meralgia paresthetica regardless of a previously performed neurolysis procedure. This finding suggests that the intraneural changes that occur in persistent meralgia paresthetica are largely irreversible and support the surgical strategy of neurectomy as an alternative to neurolysis, also for primary surgical treatment and not only after failure of neurolysis.
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Malessy MJA, Eekhof J, Pondaag W. Dynamic decompression of the lateral femoral cutaneous nerve to treat meralgia paresthetica: technique and results. J Neurosurg 2018; 131:1552-1560. [PMID: 30544337 DOI: 10.3171/2018.9.jns182004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The results of lateral femoral cutaneous nerve (LFCN) decompression to treat idiopathic meralgia paresthetica (iMP) vary widely. Techniques to decompress the LFCN differ, which may affect outcome, but in MP it is unknown to what extent. The authors present a new technique using dynamic decompression and discuss the outcomes. METHODS A retrospective cohort study was performed in a consecutive series of 19 cases. The goal of decompression was pain relief and recovery of sensation. The plane ventral to the LFCN was decompressed by cutting the fascia lata and the inferior aspect of the inguinal ligament. The plane dorsal to the LFCN was decompressed by cutting the fascia of the sartorius muscle. Subsequently, the thigh was brought in full range of flexion and extension/abduction. The authors identified and additionally cut fibers that tightened and caused compression at various locations of the LFCN during movement in all patients, referring to this technique as dynamic decompression. Postoperatively, an independent neurologist scored pain and sensation on a 4-point scale: completely resolved, improved, not changed, or worsened. Patients scored their remaining pain or sensory deficit as a percentage of the preoperative level. Statistical assessment was done using ANOVA to assess the association between outcome and duration of preoperative symptoms, BMI, and length of follow-up. RESULTS In 17 of the 19 cases (89%), the pain and/or paresthesia completely resolved. Patients in the remaining 2 cases (11%) experienced 70% and 80% reduction in pain. Sensation completely recovered in 13 of the 19 cases (69%). In 5 of the 19 cases (26%) sensation improved, but an area of hypesthesia remained. Four of these 5 patients indicated a sensory improvement of more than 75%, and the remaining patient had 50% improvement. Sensation remained unchanged in 1 case (5%) with persisting hypesthesia and mild hyperesthesia. There was no significant impact of preoperative symptom duration, BMI, and length of follow-up on postoperative outcome. CONCLUSIONS Dynamic decompression of the LFCN is an effective technique for the treatment of iMP. Most patients become completely pain free and sensation recovers considerably.
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Affiliation(s)
- Martijn J A Malessy
- 1Leiden University Medical Center, and
- 2Alrijne Medical Center, Leiden, The Netherlands
| | - Job Eekhof
- 2Alrijne Medical Center, Leiden, The Netherlands
| | - Willem Pondaag
- 1Leiden University Medical Center, and
- 2Alrijne Medical Center, Leiden, The Netherlands
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Morimoto D, Kim K, Kokubo R, Kitamura T, Iwamoto N, Matsumoto J, Sugawara A, Isu T, Morita A. Deep Decompression of the Lateral Femoral Cutaneous Nerve Under Local Anesthesia. World Neurosurg 2018; 118:e659-e665. [DOI: 10.1016/j.wneu.2018.06.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Schwaiger K, Panzenbeck P, Purschke M, Russe E, Kaplan R, Heinrich K, Mandal P, Wechselberger G. 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:e11914. [PMID: 30113491 PMCID: PMC6113044 DOI: 10.1097/md.0000000000011914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Meralgia paresthetica (MP) is a rare lateral femoral cutaneous nerve-(LFCN)-mononeuropathy. Treatment for this disorder includes conservative and operative approaches; the latter is considered if conservative therapy fails. The most commonly used surgical approaches are decompression/neurolysis and avulsion/neurectomy. However, there are no definitive guidelines on the optimal surgical approach to be used. The purpose of this study was to evaluate the outcome of surgical decompression of the LFCN for the treatment of persistent MP with preservation of sensation along the distribution of the LFCN.We evaluated the outcomes of LFCN procedures performed between 2015 and 2016. A total of 16 surgical decompressions could be identified. Retrospective analysis of prospectively collected patient data was performed, as well as systematic evaluation of the postoperative course, with regular follow-up examinations based on a standardized protocol. Pain was analyzed using an NRS (numeric rating scale). Several postsurgical parameters, including temperature hypersensitivity and numbness in the LFCN region, were compared with the presurgical data.Sixty-nine percent of patients had histories of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses, 2 had previous falls. Postoperatively, a significant reduction of 6.6 points in the mean NRS pain value was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.Previous studies favor either avulsion/neurectomy as the preferred procedure for MP treatment, or provide no recommendation. Our findings instead confirm the decompression/neurolysis approach as the primary surgical procedure of choice for the treatment of MP, if conservative treatment fails.
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Affiliation(s)
- Karl Schwaiger
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Paul Panzenbeck
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elisabeth Russe
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | | | | | - Gottfried Wechselberger
- Hospital of St. John of God (Barmherzige Brüder) Salzburg, Department of Plastic, Aesthetic and Reconstructive Surgery, Paracelsus Medical University, Salzburg, Austria
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Payne RA, Harbaugh K, Specht CS, Rizk E. Correlation of Histopathology and Clinical Symptoms in Meralgia Paresthetica. Cureus 2017; 9:e1789. [PMID: 29279815 PMCID: PMC5738219 DOI: 10.7759/cureus.1789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Meralgia paresthetica is a neuropathic pain disorder resulting from an entrapment neuropathy of the lateral femoral cutaneous nerve. This condition results in pain, paresthesias and numbness over the anterolateral aspect of the thigh. We present a case of meralgia paresthetica and discuss both the clinical and histopathological findings as they relate to one another. We report a case of meralgia paresthetica refractory to conservative treatment who underwent neurectomy with successful treatment of symptoms. Histopathological examination revealed moderate loss of myelinated axons with some axonal atrophy. The distinct pathologic findings were axonal regeneration clusters and thinly myelinated axons as well as moderate perineurial thickening. These findings corresponded well to the patient’s preoperative symptoms of paresthesias and pain. This case serves to shed light on the pathophysiology of meralgia paresthetica and its clinical presentation. It also shows the role of surgical treatment in cases refractory to conservative management in order to alleviate painful symptoms
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Affiliation(s)
- Russell A Payne
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | | | - Elias Rizk
- Department of Neurosurgery, Penn State Hershey Medical Center
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