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Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica?

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Abstract

Background

Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LCFN). Surgical treatment involves transection or decompression of the LCFN. There is no clear consensus on the superiority of one technique over the other. We performed a systematic review of the literature to answer this question.

Methods

Eligible studies included those that compared neurolysis versus neurectomy for the treatment of meralgia paresthetica after failure of conservative therapy. Our outcome of interest was resolution of symptoms. We performed a computerized search of MEDLINE (PubMed; all years) and of the Cochrane Central Register of Controlled Trials. Eligible studies had to include the words “meralgia paresthetica” and “surgery.” All patients regardless of age were included, and there was no language restriction. We then reviewed the articles’ titles and abstracts. All studies that compared neurolysis to neurectomy were included in the analysis.

Results

Of the studies identified, none were randomized controlled trials. There were two German language articles that were translated by a third researcher.

Each study was evaluated by two independent researchers who assigned a level of evidence according to American Association of Neurologist algorithm and also performed data extraction (neurolysis vs. neurectomy and resolution of pain symptoms). Each study was found to be level four evidence.

Conclusion

After reviewing the data, there was insufficient evidence to recommended one method of treatment over the other. This highlights the importance of keeping a national registry in order to compare outcomes between the two methods of treatment.

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Authors and Affiliations

  1. Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, 30 Hope Drive, Building B, Suite 1200, Hershey, PA, 17033, USA

    Russell Payne, Emily Sieg, Sara Langan, Kimberly Harbaugh & Elias Rizk

  2. Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA

    Scott Seaman

Authors
  1. Russell Payne
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  2. Scott Seaman
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  3. Emily Sieg
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  4. Sara Langan
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  5. Kimberly Harbaugh
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  6. Elias Rizk
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Corresponding author

Correspondence to Russell Payne.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with human participants performed by any of the authors.

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Comments

The authors are to be commended on rigorously reviewing the literature for studies comparing the efficacy of decompression versus neurectomy of the lateral femoral cutaneous nerve in patients with a clinical diagnosis of merralgia paresthetica refractory to non-surgical therapies. It is humbling to realize that despite 131 years having elapsed since the first surgical procedure for this condition, we still have no definitive study comparing the two types of surgical procedure for this condition. The authors make the very good point that surgical registries should be kept so that such a comparison can be made going forward. Although not the major focus of this article, I wonder if the authors would like to comment on the potential downside of performing a neurectomy that results in long-lasting analgesia in the distribution of the lateral femoral cutaneous nerve, which can produce unpleasant paresthesias. The authors also mention steroid injections as both a treatment and diagnostic test but do not mention injections of local anesthetic to help in diagnosing this condition. The authors also might want to at least mention the growing ultrasound literature showing the ability to both help diagnose and surgically treat this condition by being able to preoperatively localize the nerve, which can sometimes be a challenge to find.

Michel Kliot

Illinois, USA

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Payne, R., Seaman, S., Sieg, E. et al. Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica?. Acta Neurochir 159, 931–936 (2017). https://doi.org/10.1007/s00701-017-3136-x

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  • DOI: https://doi.org/10.1007/s00701-017-3136-x

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