Treatment of idiopathic meralgia paresthetica – is there reliable evidence yet?

ABSTRACT

Objective

Meralgia paresthetica is a common condition that is usually diagnosed by its classical clinical presentation and by exclusion of a spinal origin of pain, sensory loss, and/or paresthesias in the anterolateral thigh. Treatment modalities include conservative management, local injections, and surgical therapy. To date, no level 1 evidence exists about treatment options for idiopathic meralgia paresthetica. This review article aims to give a structured overview of epidemiology, history, anatomy, diagnostics, and treatment. It focuses on the existing literature and current developments in clinical management.

Methods

A literature search on PubMed/MEDLINE was performed on 20 December 2021, yielding 1412 results. Abstracts were screened and classified in terms of epidemiology, anatomy, diagnostics, and treatment.

Results

High-quality observational data that was included in recent meta-analyses showed satisfactory results for conservative management, injections, and surgical decompression or neurectomy, but there is some major methodological criticism. For idiopathic meralgia paresthetica, the results of surgical decompression have never been compared to those of neurectomy in a randomized setup. The only study protocol published so far does not consider any extended decompression techniques (dynamic, circumferent, proximal, and distal to the inguinal ligament). A multicenter, prospective design has never been proposed.

Discussion

Reliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain.

KEYWORDS:

• Meralgia paresthetica
• lateral femoral cutaneous nerve
• decompression
• neurolysis
• neurectomy
• injection

Disclosure statement

Nora F. Dengler was funded by the institutional Rahel Hirsch and Lydia Rabinowitsch scholarships, and received public body founding for the project GoSafe (Horizon 2020, 870144). She received speaker honoraria from Integra Lifesciences and serves as advisor for Alexion pharmaceuticals. None of the funding bodies had any role in design, data, collection, decision to publish or preparation of this manuscript.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.

Notes on contributors

Nora F. Dengler

Nora F. Dengler is a senior Neurosurgeon at Charité Universitaetsmedizin Berlin, Germany with special interests in skull base, vascular, and peripheral nerve surgery. She currently serves as chair of the peripheral nerve surgery section of the german neurosurgical society (DGNC) and as board and comitee member of the peripheral nerve surgery sections of the european association of neurosurgical societies (EANS) and the world federation of neurosurgeons (WFNS).