Objective: To understand the pathologic and clinical correlates of patients with chronic meralgia paresthetica (MP) undergoing lateral femoral cutaneous nerve (LFCN) neurectomy.Methods: A retrospective cohort approach was utilized to identify 7 patients undergoing LFCN neurectomy for intractable pain. Control autopsied LFCN was obtained. Clinical, radiologic, and electrophysiologic features were reviewed.Results: In identified cases, preoperative symptoms included severe lateral thigh pain and numbness. The duration of symptoms prior to surgery ranged from 2 to 15 years. Body mass index (BMI) varied from 20 kg/m 2 to 44.8 kg/m 2 (normal-morbidly obese), with 6 out of 7 patients being obese. No patients were diabetic. Focal nerve indentation at the inguinal ligament was seen intraoperatively and on gross pathology in 4 of 7 cases. Multifocal fiber loss, selective loss of large myelinated fibers, thinly myelinated profiles, regenerating nerve clusters, perineurial thickening, and subperineurial edema were seen. None of these features were observed in control nerve. Morphometric analysis confirmed loss of large myelinated fibers with small and intermediate size fiber predominance. Five patients had varying degrees of intraneural and epineurial inflammation. Six of 7 reported improved pain after neurectomy, sometimes dramatic. Meralgia paresthetica (MP) has been found to be relatively common, with an incidence of 32.6-43 per 100,000 patient-years.1,2 The incidence is greatest in older persons (55-64 years) with elevated body mass index (BMI), which supports the theory that mechanical compression plays a role.1 However, a strong association between diabetes and MP was also found, which was not explained by the increase in BMI alone, suggesting that diabetes may be an independent risk factor for MP. Specifically considered in the lateral femoral cutaneous nerve (LFCN), pathologic mechanisms of MP are (1) compression at the inguinal ligament from obesity; (2) injury susceptibility related to elevated blood sugars; or (3) an inflammatory or autoimmune mechanism as occurs in diabetic and nondiabetic lumbosacral plexitis, which commonly affects the femoral nerve.