Abstract
ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.
Highlights
Meralgia paresthetica is the compressive mononeuropathy of the lateral cutaneous nerve of the thigh and can cause discomfort and neuropathic pain in the anterolateral region of the thigh.[1]
Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month
Meralgia paresthetica was observed in 81 patients (22%), 77 (95%) of whom were diagnosed during the first postoperative week; in four patients (5%) it occurred during the second week
Summary
Meralgia paresthetica is the compressive mononeuropathy of the lateral cutaneous nerve of the thigh (or lateral cutaneous femoral nerve) and can cause discomfort and neuropathic pain in the anterolateral region of the thigh.[1]. It is estimated that the incidence of meralgia paresthetica following lumbar spine surgery in the prone position is approximately 20%.2,3 Despite being a relatively common complication, there are few reports in the international literature and none in the Latin American,[3,4,5] as well as an absence of focus on the management of refractory cases
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