Lateral Femoral Cutaneous Nerve Transposition With Ultrasound-Guided Wire Localization: 2-Dimensional Operative Video

Meralgia paresthetica (MP, aka Lateral Femoral Cutaneous Entrapment) presents as burning dysesthesia in the upper anterolateral thigh, typically unilateral in location. Compression classically occurs as the nerve (a sensory nerve from the L2 andL3 roots) enters the thigh where anatomic variants exist. The nerve can pass deep, superficial, or through the inguinal ligament as well as lateral or medial to the anterior superior iliac spine.(MP)-M-1 predominately occurs in obese patients and has a higher incidence in diabetic patients. The majority of patients will improve with nonsurgical management which includes weight loss, strength training, removing offending agents(eg, belts, braces),nonsteroidal anti inflammatory drug trials, ointments, and local anesthetic injections. Surgical treatment includes decompression, decompression and transposition,L2 nerve stimulation, and neurectomy. Dissection of the anterior thigh can be nuanced, risking iatrogenic nerve injury. Ultrasound-guided wire localization may reduce this risk, operative time, and failure and recurrence rates. (2-5) Here, we present ultrasound-guided wire localization for lateral femoral cutaneous nerve decompression and transposition in a patient with left MP. The nerve in this case is lateral to the anterior superior iliac spine, a rare finding in cadavers, but one commonly encountered in our practice. Written informed consent was obtained from the patient before the procedure and publication.