This gentleman had been treated by a very thoughtful team of physicians caring for him for meralgia paresthetica or compression of the lateral femoral cutaneous nerve for years. This caused terrible burning pain and electrical shooting pain and hypersensitivity into the lateral thigh down to the level of the knee. This is a constant discomfort present 24/7.
Typically, this pain is made worse while seated at 90 degrees such as on a toilet seat or car seat are sitting at the kitchen table. Frequently patients will sit reclined at a chair to prevent the burning. At times it makes it very difficult to wear pants or a dress or to have anyone touch the side of the thigh. Several patients have reported changing sides of the bed if they have a partner that touches the thigh while sleeping.
This patient would undergo ablation procedures where the nerve is treated with a radiofrequency wave or cryoablation. This would help him for a few months at a time, but his pain would never completely go away and would return to its previous level after a few months as the nerve continued to recover. He required multiple treatments over time. The patient began looking for a longer-term treatment that would be permanent rather than temporary.
We divided the lateral femoral cutaneous nerve and implanted the nerve deep into the pelvis through a small incision. This is performed as an outpatient procedure, no hospitalization is required. In this situation, the patient trades off a painful sensation for numbness in the thigh. The numbness was a welcome response.
Over time the area of numbness does shrink.
Some patients will improve dramatically with a decompression of the nerve. This preserves the sensation in the thigh by keeping the nerve intact but taking pressure off of the nerve as it exits the pelvis and travels into the out thigh. However, given this patient's extensive history of ablation procedures, we elected to remove this branch. Fortunately, he is doing very well.
