Meralgia paresthetica

Abstract

Meralgia paresthetica is a compression neuropathy of the lateral femoral cutaneous nerve. Despite its rarity, it is the most common nerve entrapment of the lower limbs. It produces similar symptoms as those associated with the more common L4 or L5 radiculopathy. Therefore, it is often diagnosed late (sometimes only after several years of latency) or not at all. This diagnosis should be considered especially in patients with obesity and diabetes who have chronic irritation of the ventrolateral areas of the thigh not responding to conservative therapy and a negative finding on lumbar MRI.
We present our experience with surgical nerve decompression in three patients with pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. They all suffered from severe abdominal obesity. All conservative treatments, including weight reduction attempts, were unsuccessful. Nerve release caused an immediate effect in two cases. One patient experienced a temporary worsening of pain, which gradually improved within one month.
In spite of the controversy surrounding the surgical treatment of meralgia (neurolysis or nerve resection), it can be concluded that nerve decompression has a good effect. Nerve resection is, in our view, considered to be a reserve option when primary surgery fails.