Dharmasaroja Pornpatr, Dharmasaroja Permphan
Division of Neurology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
J Med Assoc Thai. 2010 Dec;93 Suppl 7:S307-10.
Meralgia paresthetica is a well-known sensory syndrome describing paresthesia and/or anesthesia in the anterolateral aspect of the thigh that is supplied by the lateral femoral cutaneous nerve. Compression of the nerve usually occurs at the point where it passes between the anterior superior iliac spine and the inguinal ligament. Proximal lesions such as lumbar radiculopathy, lumbar disc herniation, and spinal stenosis have been reported to cause meralgia paresthetica-like syndrome. These proximal lesions directly injure L2 and L3 spinal nerve roots and cause a constant compression of the nerve roots. The presented paper introduces a hypothesis that this syndrome can be caused by transient injury to the L2 and L3 nerve roots by the upper adjacent disc bulge without definite compression. This hypothesis is supported by lumbar spine magnetic resonance imaging of a patient presenting with a meralgia paresthetica-like symptom during bending forward and twisting of the body, showing no L2/L3 herniated disc but mildly posterior bulging of T12/L1 disc. This hypothesis emphasizes an importance of appropriate postures in patients with meralgia paresthetica-like symptoms in order to prevent long-term morbidity.
股外侧皮神经痛是一种著名的感觉综合征,表现为股外侧皮神经所支配的大腿前外侧出现感觉异常和/或麻木。神经受压通常发生在其穿过髂前上棘和腹股沟韧带之间的部位。据报道,诸如腰椎神经根病、腰椎间盘突出症和椎管狭窄等近端病变可导致类似股外侧皮神经痛的综合征。这些近端病变直接损伤L2和L3脊神经根,并导致神经根持续受压。本文提出一种假说,即该综合征可能由上邻椎间盘膨出对L2和L3神经根造成短暂损伤而引起,且无明确压迫。一名在身体前屈和扭转时出现类似股外侧皮神经痛症状的患者的腰椎磁共振成像支持了这一假说,该成像显示无L2/L3椎间盘突出,但T12/L1椎间盘轻度向后膨出。这一假说强调了对于有类似股外侧皮神经痛症状的患者而言,保持适当姿势以预防长期发病的重要性。