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A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

After successful applications of the ultra-minimally invasive thread transecting technique (Guo Technique) for both thread carpal tunnel release and thread trigger finger release, we hypothesized that this technique could be used for superficial peroneal nerve release in the lower leg by selective crural fasciectomy. This study is aimed at testing the operative feasibility of performing the thread superficial peroneal nerve release (TSPNR) procedure in cadavers.

Methods

The TSPNR procedure was performed on 15 fresh frozen cadaveric lower-extremity specimens under ultrasound guidance. All cadaveric specimens were dissected and visually assessed immediately after the procedures.

Results

All 15 legs demonstrated a complete transection of the crural fasciae along the course of the superficial peroneal nerve (SPN) including where it penetrated and traversed the crural fascia. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 20 min.

Conclusion

This cadaveric study demonstrated that the technique of TSPNR was accurate, reliable, and feasible while causing no injury to adjacent neurovascular structures and avoiding having to make a skin incision. Further studies are warranted to verify the results of this study before implementing this new technique in the clinical setting.

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Abbreviations

TSPNR:

Thread superficial peroneal nerve release

SPN:

Superficial peroneal nerve

TCTR:

Thread carpal tunnel release

TTFR:

Thread trigger finger release

D:

Distal point

DM:

Distal margin

P:

Proximal point

PM:

Proximal margin

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Acknowledgements

The authors would like to thank Dennis Dykstra, M.D., Ph.D. for his ongoing support.

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Authors and Affiliations

  1. BayCare Clinic Pain & Rehab Medicine, Aurora/BayCare Health, BayPark 2401 Holmgren Way, Green Bay, WI, 54304, USA

    Danzhu Guo, Danqing Guo & Richard Harrison

  2. Department of Rehabilitation Medicine Division of PM&R, University of Minnesota, 420 Delaware St. SE MMC 297, Minneapolis, MN, 55455, USA

    Logan McCool & Brionn Tonkin

  3. Guilford Orthopedics and Sports Medicine Center, 1915 Lendew Street, Greensboro, NC, 27408, USA

    Hao Wang

  4. Department of Neurosurgery, Stanford University, 300 Pasteur Dr, Palo Alto, CA, 94304, USA

    Michel Kliot

Authors
  1. Danzhu Guo
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  2. Danqing Guo
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  3. Richard Harrison
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  4. Logan McCool
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  5. Hao Wang
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  6. Brionn Tonkin
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  7. Michel Kliot
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Corresponding author

Correspondence to Danqing Guo.

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Conflict of interest

Two of the authors, Danzhu Guo and Danqing Guo, are brothers to Joseph Guo who is the inventor of the Loop & Sheer thread. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Neurosurgical technique evaluation

Electronic supplementary material

The arrow indicates the superficial peroneal nerve as it courses distally piercing through the crural fascia, and the moving white dots above the superficial peroneal nerve are the thread looping the crural fascia (MP4 7976 kb)

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Guo, D., Guo, D., Harrison, R. et al. A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg. Acta Neurochir 161, 2133–2139 (2019). https://doi.org/10.1007/s00701-019-03944-y

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  • DOI: https://doi.org/10.1007/s00701-019-03944-y

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