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Comparison of Effectiveness Of Different Surgical Treatments for Meralgia Paresthetica: Results of a Prospective Observational Study and Protocol for a Randomized Controlled Trial
Godard C.W. de Ruiter, MD; Fred Kloet, Neurosurgery
Medical Center Haaglanden, The Hague, Netherlands
Introduction: Various surgical procedures can be applied in the treatment of meralgia paresthetica, including neurolysis and neurectomy of the lateral femoral cutaneous nerve. To date, no randomized controlled trial has been reported on the effectiveness of these procedures. In this study we present the results of a prospective observational study and the protocol for a double blind randomized controlled trial, both aimed at comparing the outcome for neurolysis and neurectomy.
Methods and analysis: All patients that were surgically treated for persistent symptoms of idiopathic meralgia paresthetica were included. The decision for the type of treatment (neurolysis or neurectomy) was left to the patient after informed consent. Primary outcome was measured using the Likert scale (ranging from 1-7), which was obtained 6 weeks after the surgery. Successful pain reduction was defined as Likert 1 or 2. Secondary outcome measures were the Numeric Rating Scale (NRS, rating pain from 0-10) and Bothersomeness Index (BSI, rating the degree the patient is bothered from 0-6). In addition, after neurectomy the BSI for numbness was obtained (also rated from 0-6).
Results: Between August 2012 and April 2014 a total of 22 patients were operated: in 8 patients the neurolysis procedure was performed and in 14 patients the neurectomy procedure (one bilateral case). Successful pain reduction was observed more frequently after neurectomy (93,3%) than after neurolysis (37,5%, P < 0.05). Secondary outcome scores (NRS and BSI for pain) were also better after neurectomy, although not significantly (respectively P = 0.07 and 0.05). Paired analysis of the scores before and after the surgery showed an improvement in both the NRS and BSI after the neurectomy procedure (both P < 0.001), while scores were not significantly different before and after the neurolysis procedure (respectively P = 0.25 and 0.125). Interestingly, scores for the BSI for numbness after the neurectomy procedure were low (mean 1.4, SD +/- 1.0, range 0-3).
Discussion: This prospective observational study confirms results from our previous retrospective study which showed better results after the neurectomy procedure [1]. In addition, the results show that the impact of numbness after the neurectomy is low. Currently, we are undertaking a randomized controlled trial to investigate the difference in a double blind fashion. The same outcome measures presented in this study are thereby used.
1. de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta neurochirurgica. 2012;154(10):1765-72.
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