Meralgia paresthetica (MP) lacks consensus on diagnostic criteria for surgical candidates. This study reviews the literature to identify the most common criteria for determining MP surgical candidates and their impact on surgical outcomes. A literature search using PubMed, MEDLINE, and Google Scholar was conducted for MP surgical outcome studies. Studies were evaluated using methodical index for non-randomized studies (MINORS) criteria, and diagnostic criteria were compared. Twenty-one studies were identified with inclusion of 616 surgical results involving decompression or neurectomy of the lateral femoral cutaneous nerve (LFCN). The most used diagnostic criteria were patient history (100%), response to LFCN injection (90%), and spinal imaging (57%). Positive outcomes were noted in 84.7% of cases. History and LFCN injection were effective for diagnosing MP, while EMG was useful to rule out other pathologies. The combination of appropriate patient history and positive response to LFCN injection is a common and sufficient diagnostic method to effectively identify MP patients who are likely to benefit from surgical decompression or neurectomy. Additionally, EMG may be useful as a supplemental test to rule out non-MP diagnoses. Level III systematic review.
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