Clinical outcomes following transposition of the lateral femoral cutaneous nerve for meralgia paresthetica: a prospective case series.

Abstract

Meralgia paresthetica (MP) is a neuropathy of the lateral femoral cutaneous nerve (LFCN) manifested by burning pain, allodynia, and sensory loss in the anterolateral thigh. While simple decompression is commonly performed in patients who do not respond to nonoperative measures, LFCN transposition is an alternative technique for which rates of symptomatic relief and surgical complications are presently poorly understood. The authors report the largest prospective case series of outcomes from a series of consecutive patients who underwent LFCN transposition for refractory MP. Patients with idiopathic MP who underwent LFCN transposition by a single surgeon between 2017 and 2024 were prospectively recruited for the study and followed up for a minimum of 1 year postoperatively. Patients with prior ipsilateral decompression or traumatic/iatrogenic etiology were excluded. The primary outcome was improvement in preoperative symptoms, including pain by numeric rating scale (NRS), burning, allodynia, and hypesthesia. Secondary outcomes included rates of postoperative complications. The authors identified 51 surgically treated patients, of whom 37 met final inclusion criteria. The mean age was 52.5 ± 10.7 years, and the mean BMI was 34.1 ± 7.3 kg/m2. Preoperatively, 73.0% of patients reported burning, 56.8% reported allodynia, and 97.3% had hypesthesia. The mean total operative duration was 116.8 minutes with a skin-to-nerve time of 8.5 minutes. At a mean follow-up of 14.9 months, 66.7% of patients experienced resolution or improvement in burning, 61.9% had improvement in allodynia, and 47.2% reported improved hypesthesia. The mean reduction in the NRS pain score was 6.5 ± 2.8 points, with 89.2% of patients reporting improvement in ≥ 50% of preoperative pain by the final follow-up. In the largest prospective study of LFCN transposition to date, patients with refractory noniatrogenic MP experienced meaningful improvement in preoperative symptoms, with the most common postsurgical complication being superficial surgical site infection managed nonoperatively.