Neurolysis versus Neurectomy for Meralgia Paresthetica: A Double-Blind Randomized Controlled Trial

Abstract

Neurolysis and neurectomy of the lateral femoral cutaneous nerve are the two main surgical treatment options for meralgia paresthetica (MP). Neurectomy has been reported to be more effective, but has the consequence of complete loss of sensation in the anterolateral part of the thigh. The objective of this double-blind randomized controlled trial was to compare the effectiveness of the neurolysis and neurectomy procedure.

Sixty-four patients with persistent symptoms of idiopathic MP despite conservative treatment were randomized between neurolysis and neurectomy and followed for 1 year. The primary outcome measure was (almost) complete resolution of pain symptoms (Likert 1 and 2) 3 months after the procedure. Secondary outcome measures included visual analogue scores and the Bother Someness Index (BSI) for pain and numbness. Subgroup analysis was performed for duration of symptoms and body mass index (BMI).

No significant difference in the primary outcome was observed 3 months after neurolysis and neurectomy (p-value: 0.076). Secondary outcome measures also showed no significant differences, except for BSI pain, which demonstrated that participants were significantly less bothered by pain after neurectomy (p = 0.03). Interestingly, BSI numbness was not significantly different for the two groups. No significant differences were found for subgroup analysis of duration of symptoms and BMI. Re-operation rate was higher after neurolysis (50%).

Neurolysis is as effective as neurectomy in pain reduction at 3 months. Because neurectomy is associated with loss of sensation, neurolysis is preferred as the primary procedure. Patients should be informed, however, of the potential need for a secondary procedure.