Surgical Management of Meralgia Paresthetica: A Case Series
Poster #: 083
Session/Time: B
Author:
Aaron Lerner, BS
Mentor:
Lawrence Colen, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN) that may require surgery when conservative treatment fails. In diabetes mellitus (DM), chronic hyperglycemia impairs nerve function, and under the double crush syndrome hypothesis, this systemic dysfunction may heighten susceptibility to local nerve compression. This study evaluates surgical outcomes in MP, with a focus on the impact of DM.
METHODS:
This single-center, retrospective case series included patients with MP who underwent surgical decompression of the LFCN by a single surgeon.
RESULTS:
Sixteen limbs were included, comprising four DM and twelve non-DM limbs. The mean age was 45.4 ± 11.5 years in the DM group and 57.9 ± 20.0 years in the non-DM group. Mean BMI was higher in DM limbs (36.0 ± 3.0) compared to non-DM limbs (29.3 ± 7.4). Preoperative findings in DM vs. non-DM limbs included peripheral neuropathy (50% vs. 45%), pain (100% vs. 45%), numbness (75% vs. 55%), and a positive Tinel's sign (50% vs. 9%). All patients had failed prior conservative treatment, including LFCN blocks and corticosteroid injections. Intraoperative findings of LFCN compression and/or scarring were noted in 75% of DM limbs and 55% of non-DM limbs. Postoperative complication rates were comparable (25% DM vs. 18% non-DM). Symptom recurrence was significantly higher in DM limbs (p = 0.035). DM status was also significantly associated with reduced rates of partial symptom improvement (p = 0.027) and complete symptom resolution (p = 0.038), as well as increased need for revision neurectomy (p = 0.007). Among DM limbs, complete symptom resolution occurred in 3 of 4 cases-but only following revision neurectomy.
CONCLUSION:
These findings suggest that surgical decompression may be insufficient for patients with DM due to underlying peripheral nerve dysfunction, consistent with the double crush syndrome hypothesis. Tailored operative strategies, including early consideration of neurectomy, may be more appropriate in this population. Larger, prospective studies are needed to confirm these results and guide optimal surgical management for DM patients with MP.
Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN) that may require surgery when conservative treatment fails. In diabetes mellitus (DM), chronic hyperglycemia impairs nerve function, and under the double crush syndrome hypothesis, this systemic dysfunction may heighten susceptibility to local nerve compression. This study evaluates surgical outcomes in MP, with a focus on the impact of DM.
METHODS:
This single-center, retrospective case series included patients with MP who underwent surgical decompression of the LFCN by a single surgeon.
RESULTS:
Sixteen limbs were included, comprising four DM and twelve non-DM limbs. The mean age was 45.4 ± 11.5 years in the DM group and 57.9 ± 20.0 years in the non-DM group. Mean BMI was higher in DM limbs (36.0 ± 3.0) compared to non-DM limbs (29.3 ± 7.4). Preoperative findings in DM vs. non-DM limbs included peripheral neuropathy (50% vs. 45%), pain (100% vs. 45%), numbness (75% vs. 55%), and a positive Tinel's sign (50% vs. 9%). All patients had failed prior conservative treatment, including LFCN blocks and corticosteroid injections. Intraoperative findings of LFCN compression and/or scarring were noted in 75% of DM limbs and 55% of non-DM limbs. Postoperative complication rates were comparable (25% DM vs. 18% non-DM). Symptom recurrence was significantly higher in DM limbs (p = 0.035). DM status was also significantly associated with reduced rates of partial symptom improvement (p = 0.027) and complete symptom resolution (p = 0.038), as well as increased need for revision neurectomy (p = 0.007). Among DM limbs, complete symptom resolution occurred in 3 of 4 cases-but only following revision neurectomy.
CONCLUSION:
These findings suggest that surgical decompression may be insufficient for patients with DM due to underlying peripheral nerve dysfunction, consistent with the double crush syndrome hypothesis. Tailored operative strategies, including early consideration of neurectomy, may be more appropriate in this population. Larger, prospective studies are needed to confirm these results and guide optimal surgical management for DM patients with MP.