Interstitial electrical nerve stimulation in combination with perineural injections of corticosteroids in the treatment of paresthetic meralgia

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Abstract

BACKGROUND: Paresthetic meralgia is a neuropathy caused by compression, pinching or stretching of the lateral femoral cutaneous nerve between the inguinal ligament and the anterior superior iliac spine.

AIM: to study the effectiveness of interstitial electrical nerve stimulation in combination with perineural corticosteroid injections in the treatment of paresthetic meralgia.

MATERIALS AND METHODS: We observed 30 patients with bilateral paresthetic meralgia. All patients suffered from numbness, tingling, and pain in the lateral thighs. Our study included only patients with bilateral lesions and severe pain. Patients were divided into 3 groups. The first group ― 10 patients underwent drug therapy (control group). The 2nd group included 10 patients who, in addition to drug therapy, underwent a course of perineural corticosteroid injections. The third group included 10 patients who, in addition to drug therapy, underwent a course perineural corticosteroid injections and interstitial electrical nerve stimulation.

RESULTS: The obtained results prove the high efficacy of perineural corticosteroid injections in the treatment of paresthetic meralgia in comparison with the exclusive use of medical therapy. At the same time, the analgesic effect increased by 2.17 times, the regression of positive sensory symptoms increased by 1.2 times, sensitivity improved by 2 times and the quality of life of patients in the physical and mental spheres significantly improved. The use of interstitial electrical nerve stimulation after perineural corticosteroid injections exceeded the effectiveness of perineural corticosteroid injections in reducing pain by 98%, regressing positive sensory symptoms by 63%, reducing the zone of hypesthesia by 2 times and improving the quality of life in the physical and mental components of SF-36 by an average of 2 times.

CONCLUSIONS: It is recommended to perform perineural corticosteroid injections in the treatment of patients with paresthetic meralgia, followed by the use of interstitial electrical nerve stimulation.

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About the authors

Mustafa Kh. Al-Zamil

Peoples' Friendship University of Russia; Brain and Spine Clinic

Author for correspondence.
Email: alzamil@mail.ru
ORCID iD: 0000-0002-3643-982X
SPIN-code: 3434-9150

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Podolsk

Natalia G. Kulikova

Peoples' Friendship University of Russia; National Medical Research Center for Rehabilitation and Balneology

Email: fbrmed@mail.ru
ORCID iD: 0000-0002-6895-0681
SPIN-code: 1827-7880

MD, Dr. Sci. (Med.), Professor

Congo, Moscow; Moscow

Ekaterina S. Vasilieva

Petrovsky National Research Centre of Surgery; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: e_vasilieva@inbox.ru
ORCID iD: 0000-0003-3087-3067
SPIN-code: 5423-8408

Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

References

  1. Heger W. Neuralgia femoris: Resection des Nervus cutaneous femoris anterior externus. Heilung. Deutsche med Wochenshr. 1885;(11):218.
  2. Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: Relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538–1542. doi: 10.1212/WNL.0b013e318233b356
  3. Dahm F, Aichmair A, Dominkus M, Hofstaetter JG. Incidence of lateral femoral cutaneous nerve lesions after direct anterior approach primary total hip arthroplasty — a literature review. Orthop Traumatol Surg Res. 2021;107(8):102956. doi: 10.1016/j.otsr.2021.102956
  4. Weng WC, Wei YC, Huang WY, et al. Risk factor analysis for meralgia paresthetica: A hospital-based study in Taiwan. J Clin Neurosci. 2017;(43):192–195. doi: 10.1016/j.jocn.2017.04.024
  5. Lo YL, Pavanni R. Electrophysiological features in the management of meralgia paraesthetica. Ann Acad Med Singap. 1998;27(4):530–532.
  6. Tataroglu С, Coban A, Sair A, Kızilay Z. Inguinal segmental nerve conduction of the lateral femoral cutaneous nerve in healthy controls and in patients with meralgia paresthetica. J Clin Neurosci. 2019;(67):40–45. doi: 10.1016/j.jocn.2019.06.027
  7. De Ridder VA, de Lange S, Popta JV. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma. 1999;13(3):207–211. doi: 10.1097/00005131-199903000-00009
  8. Carai A, Fenu G, Sechi E, et al. Anatomical variability of the lateral femoral cutaneous nerve: Findings from a surgical series. Clin Anat. 2009;22(3):365–370. doi: 10.1002/ca.20766
  9. Murata Y, Takahashi K, Yamagata M, et al. The anatomy of the lateral femoral cutaneous nerve, with special reference to the harvesting of iliac bone graft. J Bone Joint Surg Am. 2000;82(5):746–747. doi: 10.2106/00004623-200005000-00016

Supplementary files

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2. Fig. 1. Anatomy of the lateral cutaneous nerve of the thigh: 1 ― root L2; 2 ― root L3; 3 ― anterior superior spine of the iliac wing; 4 ― inguinal ligament; 5 ― lateral cutaneous nerve of the thigh.

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3. Fig. 2. Localization of hypesthesia in patients with paresthetic meralgia: 1 ― the lateral cutaneous nerve of the thigh together with the anterior cutaneous nerves of the thigh; 2 ― the anterior and posterior branches of the lateral cutaneous nerve in the patient after replacement of the right hip joint; 3 ― the anterior branch of the lateral cutaneous nerve of the thigh.

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4. Fig. 3. Electromyographic studies of the lateral cutaneous nerve of the thigh: antegrade stimulation method (a): 1 ― anterior superior spine of the iliac wing, 2 ― inguinal ligament, 3 ― popliteal cup, 4 ― nerve action potential registration points, 5 ― proximal nerve stimulation point, 6 ― lateral cutaneous nerve of the thigh, 7 ― distal nerve stimulation point; retrograde stimulation method (b): 1 ― anterior superior spine of the iliac wing, 2 ― inguinal ligament, 3 ― kneecap, 4 ― proximal nerve stimulation point, 5 ― distal nerve stimulation point, 6 ― lateral cutaneous nerve of the thigh, 7 ― points of registration of the nerve action potential.

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5. Fig. 4. Anatomical variants of the passage of the lateral cutaneous nerve of the femur between the anterior superior tip of the iliac wing and the inguinal ligament (designations 1–5, explanation in the text) [7].

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6. Fig. 5. Variants of the passage of the lateral cutaneous nerve of the femur in relation to the anterior upper spine of the iliac wing along the Murat: a ― posterior and laterally >2 cm; b ― posterior and laterally <2 cm; c ― anterior and medial <4 cm; d ― anterior and medial >4 cm.

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7. Fig. 6. Ultrasound examination of the lateral cutaneous nerve of the thigh: 1 ― anterior superior spine of the iliac wing; 2 ― lateral cutaneous nerve of the femur; 3 ― medial part of the inguinal ligament.

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8. Fig. 7. Regression of pain syndrome on a visual analog scale (VAS) against the background of the applied treatment. ПИК ― perineural injections of corticosteroids; ВТЭНС ― intracranial electroneurostimulation.

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9. Fig. 8. Regression of positive sensory symptoms against the background of the applied treatment. ПИК ― perineural injections of corticosteroids; ВТЭНС ― intracranial electroneurostimulation.

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10. Fig. 9. Regression of the area of hypesthesia after treatment compared to the baseline data before treatment, in mm. ПИК ― perineural injections of corticosteroids; ВТЭНС ― intracranial electroneurostimulation.

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11. Fig. 10. Regression of the hypesthesia zone (marked with a marker) on the patient's left and right hip after passing the ПИК+ВТЭНС. ПИК ― perineural injections of corticosteroids; ВТЭНС ― intracranial electroneurostimulation.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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