What is Lateral Femoral Cutaneous Nerve Decompression?
Lateral femoral cutaneous nerve decompression is a surgical procedure for the treatment of a medical condition known as meralgia paresthetica.
Meralgia paresthetica, also known as Bernhardt-Roth syndrome, is a neurological condition characterised by sensations of aching, stabbing, burning, or numbness in the thigh. It occurs when the lateral femoral cutaneous nerve (LFCN) that supplies sensation to the outer part of the thigh is damaged or compressed. The lateral femoral cutaneous nerve, also known as lateral cutaneous nerve of the thigh, emerges from the lumbosacral plexus, passes through the pelvis, and may travel under, above, or through the inguinal ligament on its way into the superficial thigh. Some of the factors that result in the compression of the nerve include wearing tight-fitting clothes, pregnancy, obesity, diabetes, hip injury, and seatbelt injury from a motor vehicle accident.
Indications for Lateral Femoral Cutaneous Nerve Decompression
Lateral femoral cutaneous nerve decompression surgery is recommended when conservative treatment measures such as weight control, wearing loose clothing, lifestyle changes, medications, and steroid injections have failed to resolve the symptoms associated with meralgia paresthetica. The main objective of decompression surgery is to achieve pain relief and recovery of sensation by eradicating structures pressing on the nerve as it passes through its course.
Preparation for Lateral Femoral Cutaneous Nerve Decompression
Preoperative preparation for lateral femoral cutaneous nerve decompression generally involves the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from supplements or medications such as blood-thinners or anti-inflammatories a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Lateral Femoral Cutaneous Nerve Decompression
Lateral femoral cutaneous nerve decompression procedure is usually performed as an open surgery under general anaesthesia on an outpatient basis. In general, decompression surgery will involve the following steps:
- You will lie on your back on the operating table with the affected side placed close to the edge.
- An incision is made in a lateral fashion on the affected side using loupe magnification (a device used to see small details more closely).
- The underlying muscles are carefully separated to expose the lateral femoral cutaneous nerve in the upper thigh area.
- Your surgeon evaluates the condition of the nerve and identifies soft-tissue structures causing compression of the nerve.
- The plane ventral to the lateral femoral cutaneous nerve is decompressed by cutting the fascia lata (deep tissue of the thigh) and underside of the inguinal ligament.
- The plane dorsal to the lateral femoral cutaneous nerve is decompressed by cutting the fascia of the sartorius muscle (a thin, long muscle in the anterior compartment of the thigh).
- Additionally, structures that cause compression at various locations of the lateral femoral cutaneous nerve are also identified and cut to achieve complete decompression.
- Finally, range of motion of the thigh is checked for a satisfactory result, and the incision is closed with sutures and a sterile bandage is applied.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after lateral femoral cutaneous nerve decompression will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the upper thigh area. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- Ice packs covered with a towel can be applied to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Refrain from strenuous activities and lifting heavy weights for the first few months. Gradual increase in activities over a period of time is recommended.
- An individualised physical therapy protocol will be designed to help strengthen thigh muscles and optimise thigh function.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Lateral femoral cutaneous nerve decompression is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to nerves and vessels
- Muscle trauma
- Thromboembolism or blood clots
- Anaesthetic/allergic reactions