An anatomical study to assist with treatment planning for meralgia paraesthetica
Elisabeth Russe, MD1,2, Patrick Mandal, MD1, Karl Schwaiger, MD1, Gottfried Wechselberger, MD1 and Georg Feigl, MD3, (1)Hospital of St. John of God, Salzburg, Austria, (2)Paracelsus Medical University, Salzburg, Austria, (3)Medical University Graz, Graz, Austria
Introduction: Meralgia paraesthetica is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), which results in pain and disability. Treatment often requires surgical release and thus understanding the anatomy is critical for a successful result. The literature suggests variations in the nerve course. The aim of our study was to provide more accurate measurements in order to improve the diagnostic and surgical management of meralgia paraesthetica. Materials and methods: The LFCN was dissected bilaterally in 50 Thiel-embalmed human cadavers were dissected bilaterally. Measurements were performed with a standard caliper at the superior and inferior margin of the inguinal ligament (IL) on 93 nerves (7 nerves were excluded due to previous surgeries in the inguinal area). The distance from the inner lamina of the ASIS to the lateral margin of the LFCN was measured. Data were collected and statistical analysis was done with R®. Results: The mean distance from ASIS to the most proximal point where the LFCN pierces the inguinal ligament was 20.6mm (SD 13mm). The mean distance from the ASIS to the distal point through where the LFNC exits the inguinal ligament was 18.9mm (SD 14mm). The range of values to the proximal point, where the LFCN pierces the inguinal ligament, was from 17.7mm to 23.5mm. The range of values to the inferior point, where the LFCN exits the inguinal ligament, was between 15.9mm and 21.8mm. Conclusions: A precise understanding of the course of LFCN is required to perform targeted interventions for meralgia paresthetica. This anatomical study shows, that the majority of LFCN passes beneath the inguinal ligament in a very narrow area. Understanding of this location of the LFCN will help with surgical planning. Our findings also suggest a more consistent path than described in the existing literature.
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