Comparison of effectiveness of different surgical treatments for meralgia paresthetica: Results of a prospective observational study and protocol for a randomized controlled trial.
BACKGROUND
Various surgical procedures can be applied in the treatment of meralgia paresthetica. The two main ones are neurolysis and neurectomy of the lateral femoral cutaneous nerve. To date, no prospective or randomized controlled trial has compared the effectiveness of these procedures with standardized outcome measures. In this study we present our results for two prospectively followed cohorts and we present the protocol for a double blind randomized controlled trial (RCT).


METHODS
All patients that had an indication for surgical treatment of idiopathic meralgia paresthetica between August 2012 and April 2014 were included in the study. The patient decided on the type of treatment (neurolysis or neurectomy) after informed consent had been given. Primary outcome was measured using the Likert scale 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) and Bothersomeness Index (BSI). In case of neurectomy the BSI for numbness was also obtained.


RESULTS
A total of 22 consecutive patients were included: neurolysis was performed in 8 patients and neurectomy in 14 patients (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 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. Patient's scores for the BSI numbness after the neurectomy procedure were low (mean 1.4, SD±1.0, range 0-3).


CONCLUSIONS
The results of our prospective study confirm results previous studies reported in the literature in that the percentage pain relief was better after neurectomy than after neurolysis. A RCT is needed to further investigate potential differences in effectiveness. The protocol for such a trial is presented in this article.
Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands. Electronic address: g.de.ruiter@mchaaglanden.nl.
Godard C W
GC
de Ruiter
Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands.
Alfred
A
Kloet
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004311:Double-Blind Method; D005267:Femoral Nerve / Q000473:pathology / Q000601:surgery; D020428:Femoral Neuropathy; D009408:Nerve Compression Syndromes / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D016032:Randomized Controlled Trials as Topic; D000078985:Clinical Trial Protocols as Topic
Entrapment; Nerve compression; Nerve transection; Neurectomy; Neurolysis