Transposition of the lateral femoral cutaneous nerve

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OBJECTIVE

Meralgia paresthetica causes pain, burning, and loss of sensation in the anterolateral thigh. Surgical treatment traditionally involves neurolysis or neurectomy of the lateral femoral cutaneous nerve (LFCN). After studying and publishing data on the anatomical feasibility of LFCN transposition, the author presents here the first case series of patients who underwent LFCN transposition.

METHODS

Nineteen patients with meralgia paresthetica were treated in the Department of Neurological Surgery at University of Wisconsin between 2011 and 2016; 4 patients underwent simple decompression, 5 deep decompression, and 10 medial transposition. Data were collected prospectively and analyzed retrospectively. No randomization was performed. The groups were compared in terms of pain scores (based on a numeric rating scale) and reoperation rates.

RESULTS

The numeric rating scale scores dropped significantly in the deep-decompression (p = 0.148) and transposition (p < 0.0001) groups at both the 3- and 12-month follow-up. The reoperation rates were significantly lower in the deep-decompression and transposition groups (p = 0.0454) than in the medial transposition group.

CONCLUSIONS

Both deep decompression and transposition of the LFCN provide better results than simple decompression. Medial transposition confers the advantage of mobilizing the nerve away from the anterior superior iliac spine, giving it a straighter and more relaxed course in a softer muscle bed.

ABBREVIATIONS ASIS = anterior superior iliac spine; BMI = body mass index; LFCN = lateral femoral cutaneous nerve; NRS = numeric rating scale.

Article Information

Correspondence Amgad Hanna: University of Wisconsin, Madison, WI. ah2904@yahoo.com.

INCLUDE WHEN CITING Published online April 13, 2018; DOI: 10.3171/2017.8.JNS171120.

Disclosures The author reports no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Comparison of patient NRS scores before and 3 and 12 months after surgery (all 3 treatment types). A: No significant difference in NRS scores after simple decompression was found (p = 0.0867, 1-way ANOVA). B: NRS scores of patients who underwent deep decompression changed significantly after surgery (p = 0.0148, 1-way ANOVA); scores were significantly lower 3 and 12 months after surgery than they were before surgery (p < 0.05, Tukey post hoc test). C: NRS scores of patients who underwent LFCN transposition changed significantly after surgery (p < 0.0001, 1-way ANOVA); scores were significantly lower 3 and 12 months after surgery than they were before surgery (p < 0.0001, Tukey post hoc test). Six of the 7 patients who underwent LFCN transposition were experiencing no pain 12 months after surgery and gave an NRS score of 0. Error bars represent ± the SEM.

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    Plots showing the reductions in NRS scores after surgery (all 3 treatment types). A: Three months after surgery, no significant difference in reduction in NRS scores among the 3 treatments was found (p = 0.7706, 1-way ANOVA). B: Twelve months after surgery, no significant difference between the 3 treatments in reducing the NRS score was found (p = 0.6675, 1-way ANOVA). Error bars represent ± the SEM.

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    Stacked-column chart showing the number of patients who required a second operation. When nerve transection or wound washout was considered as a reoperation, a significant difference between the treatments was found (p = 0.0454, Fisher exact test). The results were also significantly different when only nerve transection was considered a reoperation (p = 0.0351, Fisher exact test). None of the patients who underwent transposition needed a second operation. S = simple decompression; D = deep decompression; T = LFCN transposition.

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    A: Diagrammatic representation of the LFCN canal in an oblique sagittal view at the level of the ASIS. 1 = skin; 2 = subcutaneous tissue; 3 = external oblique muscle and aponeurosis; 4 = internal oblique muscle; 5 = transversus abdominis; 6 = transversalis fascia; 7 = fascia iliaca superficial lamina; 8 = retroperitoneal fat; 9 = LFCN; 10 = fascia iliaca deep lamina; 11 = iliacus; 12 = iliac bone; 13 = femur; 14 = rectus femoris; 15 = sartorius; 16 = fascia lata; 17 = LFCN canal; 18 = inguinal ligament; 19 = iliopubic tract; 20 = thickening of the fascia deep to the LFCN, here by the tendinous origin of the sartorius (can also be a slip from the inguinal ligament or periosteum if the nerve is riding over the ASIS or iliac crest). Reproduced from Hanna: The lateral femoral cutaneous nerve canal. J Neurosurg 126:972–978, 2017. Copyright Amgad Hanna. Published with permission. B: After simple decompression, the deep fascia superficial to the nerve is released, as is the inguinal ligament. : When scar tissue (21) develops, the nerve is retethered into a position very similar to that in the preoperative state (shown in A). D: With transposition, all components of the LFCN canal are opened superficial and deep to the nerve, and then the LFCN is mobilized approximately 2 cm medially. E: After transposition, the nerve acquires a much straighter and relaxed course, has a softer muscular bed, and is further away from the ASIS, even after scar tissue (21) develops. B–E: Reproduced from Hanna: Lateral femoral cutaneous nerve transposition: renaissance of an old concept in the light of new anatomy. Clin Anat 30:409–412, 2017. Copyright Wiley Periodicals. Published with permission.

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