article · The Egyptian Journal of Neurosurgery : the official publication of the Egyptian Society of Neurological Surgeons/Egyptian journal of neurosurgery
Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve that causes numbness, burning pain, and tingling along the outer thigh. When non-surgical treatments fail, surgical intervention through nerve decompression, known as neurolysis, or nerve resection, termed neurectomy, offers an alternative. An evaluation of eleven patients who underwent surgery after at least three months of unsuccessful conservative care demonstrated significant clinical improvement. Eight individuals received neurolysis and three underwent neurectomy. Across a follow-up period of up to twelve months, average pain scores dropped markedly, with all patients experiencing satisfactory or complete pain reduction. Complications included two haematomas and one superficial wound infection, whilst permanent thigh numbness occurred predictably in all neurectomy cases. Surgical intervention provides meaningful relief for refractory cases, with neurolysis preferred initially to preserve sensation and neurectomy reserved for recurrent conditions.
Meralgia paresthetica causes persistent and disruptive nerve pain that may resist standard non-surgical management. Demonstrating that surgical decompression or nerve resection provides substantial, lasting pain relief offers clear guidance for clinicians treating severe cases. Understanding the trade-offs, particularly the occurrence of permanent numbness following neurectomy, helps healthcare providers and patients select the appropriate procedure when conventional therapies fail.
The abstract does not indicate an application pathway, as it focuses exclusively on evaluating standard surgical interventions in a clinical setting.
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Abstract Objectives To assess the outcomes of surgical management — decompression (neurolysis) or neurectomy — in patients with meralgia paresthetica refractory to conservative treatment, and to describe the indications guiding the choice between the two techniques. Background Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) clinically characterised by paraesthesia, numbness and burning pain over the anterolateral aspect of the thigh. It most commonly affects adults aged 30–40 years, although it can occur at any age. Methods In this retrospective cohort study, 11 consecutive patients who had failed at least three months of conservative treatment underwent surgery (neurolysis or neurectomy) and were followed for up to 12 months. The following data were collected: age, sex, body mass index (BMI), ultrasound, plain radiography, magnetic resonance imaging (MRI) of the lumbar spine, nerve conduction studies, duration of symptoms before intervention, and previously attempted conservative treatments. The pain visual analogue scale (VAS) and thigh numbness were recorded preoperatively and at the final postoperative follow-up visit. Results Eleven patients were operated on (7 male [64%], 4 female [36%]); the mean age was 39.3 years (range, 25–52). Nine patients (82%) had spontaneous (idiopathic) MP and two (18%) had iatrogenic MP following lumbar discectomy performed in the prone position. Neurolysis was performed in eight patients (73%) and neurectomy in three (27%). The mean VAS improved from 6.1 ± 0.8 (range, 5–7) preoperatively to 1.5 ± 1.0 (range, 0–3) at final follow-up (mean reduction 4.6 points; Wilcoxon signed-rank test, p < 0.001). Two patients (18%) achieved complete pain relief and nine (82%) reported satisfactory relief. Complications occurred in three patients (27%): hematoma in two (18%) and superficial wound infection in one (9%). The expected permanent anterolateral thigh numbness occurred in the three patients treated by neurectomy (27%). Conclusion In refractory MP, conservative measures remain first-line and surgery is reserved for failures. Neurolysis is recommended as the first surgical option because it preserves thigh sensation, whereas neurectomy is reserved for refractory or recurrent cases in which the patient accepts permanent numbness. In this small cohort both procedures achieved clinically meaningful pain relief; symptom recovery may continue for up to 12 months, particularly in idiopathic/metabolic cases. Larger comparative studies are required to define the optimal technique.
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DOI: 10.1186/s41984-026-00640-9
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