Results of Dynamic Decompression of the Lateral Femoral Cutaneous Nerve in Idiopathic Meralgia Paresthetica: A Case Series of 109 Procedures.

Abstract

Different surgical techniques are used to treat idiopathic meralgia paresthetica. We analyzed the effect of neurolysis of the lateral femoral cutaneous nerve (LFCN) with intraoperative dynamic testing of the completeness of decompression. A retrospective single center study was conducted on a consecutive series of 109 procedures performed between January 2018 and January 2024. Five different postoperative outcome measures were used by an independent neurologist to assess specific meralgia symptoms and overall well-being: (1) pain and (2) skin sensation in the LFCN area, both rated on a 4-point ordinal scale (completely resolved, improved, unchanged, or worsened); (3) reduction of the area with abnormal skin sensation, measured on a 0-100 continuous scale; (4) the Global Perceived Effect, rated on a 7-point ordinal scale (much better, better, somewhat better, the same, somewhat worse, worse, or much worse); and (5) overall decrease in reported complaints rated on a 0-100 continuous scale. The correlation between outcome measures was assessed either by proportional odds model, or by linear-by-linear association test. The effect of time from onset of symptoms to surgery, body mass index, sex, and age on the reduction of complaints was evaluated using a Beta mixed effect regression model. Most of the interventions resulted in either complete or marked overall reduction of complaints (mean 87.9, SD: 17.9). The overall reduction was positively associated with the Global Perceived Effect and strongly associated with greater improvements in postoperative pain and sensory scores (P < .001). No significant impact was found of baseline covariates on the reduction of symptoms. Neurolysis of the LFCN with intraoperative dynamic testing to assess the completeness of decompression yields excellent pain reduction and improvement of sensation in the majority of idiopathic meralgia paresthetica patients. Whether dynamic testing contributes to outcomes requires a comparative study with static decompression alone.