Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica?

Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LCFN). Surgical treatment involves transection or decompression of the LCFN. There is no clear consensus on the superiority of one technique over the other. We performed a systematic review of the literature to answer this question. Eligible studies included those that compared neurolysis versus neurectomy for the treatment of meralgia paresthetica after failure of conservative therapy. Our outcome of interest was resolution of symptoms. We performed a computerized search of MEDLINE (PubMed; all years) and of the Cochrane Central Register of Controlled Trials. Eligible studies had to include the words meralgia paresthetica and surgery. All patients regardless of age were included, and there was no language restriction. We then reviewed the articles' titles and abstracts. All studies that compared neurolysis to neurectomy were included in the analysis. Of the studies identified, none were randomized controlled trials. There were two German language articles that were translated by a third researcher. Each study was evaluated by two independent researchers who assigned a level of evidence according to American Association of Neurologist algorithm and also performed data extraction (neurolysis vs. neurectomy and resolution of pain symptoms). Each study was found to be level four evidence. After reviewing the data, there was insufficient evidence to recommended one method of treatment over the other. This highlights the importance of keeping a national registry in order to compare outcomes between the two methods of treatment.