Concurrent meralgia paresthetica and radiculopathy of the left leg -A case report-

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneouse nerve (LFCN) characterized by localized symptoms of numbness, tingling, pain and paresthesia along the anterolateral thigh area. L4 and L5 radiculopathy is set of symptoms that include sharp, burning or shooting pain, which is usually localized to anterolateral leg area and along the dermatomal distribution. When symptoms of MP and lumbar disc disease occur together it is not easy to diagnose MP. We report a case of synchronous post-traumatic MP and radiculopathy due to intervertebral disc herniation at L3-4 and 4-5. A 59-year-old male patient was admitted to the emergency room with symptoms of low back pain with left severe L4, L5 radiculopathy. This patient also complained of numbness and paresthesia in the left anterolateral thigh. After detailed history taking and lateral femoral cutaneouse nerve block, he was diagnosed with MP. CASE REPORTA 59-year-old male patient was admitted to the emergency room with symptoms of lower back pain, severe pain and a tingling sensation of the left anterolateral thigh, knee and anterior part of lower leg, numbness of the left foot dorsum and big toe, and paresthesia in the left anterolateral thigh; all that had been exacerbated after playing golf that morning. The patient reported baseline numbness that began after climbing a mountain 7 days before. At the time of admittance, the patient was bedridden and could not walk due to severe pain, rated 7/10 on the numeric rating scale (NRS). A neurological examination revealed no weakness or abnormality in his reflexes.His height was 174 cm and his weight was 70 kg, with body mass index of 23.13 kg/m 2 . His past medical and surgical history were unremarkable. Lumbar magnetic resonance imaging revealed L3-4-5-S1 stenosis, L3-4, L4-5 and L5-S1 disc degeneration, left foraminal disc protrusion at L3-4, left subarticular disc protrusion at L4-5 and right paracentral disc protrusion at L5-S1 (Fig. 1). The next morning, he was referred to our pain clinic. We planned to perform caudal epidural steroid injection (ESI). After informed consent for ESI was obtained, the patient was brought to the fluoroscopy room