Acta Neurochirurgica

, Volume 161, Issue 10, pp 2133–2139 | Cite as

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

  • Danzhu Guo
  • Danqing GuoEmail author
  • Richard Harrison
  • Logan McCool
  • Hao Wang
  • Brionn Tonkin
  • Michel Kliot
Original Article - Neurosurgical technique evaluation
Part of the following topical collections:
  1. Neurosurgical technique evaluation



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.


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.


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.


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.


Superficial peroneal nerve entrapment release Leg pain Thread transecting procedure Ultrasound-guidance Ultra-minimally invasive procedure Guo technique 



Thread superficial peroneal nerve release


Superficial peroneal nerve


Thread carpal tunnel release


Thread trigger finger release


Distal point


Distal margin


Proximal point


Proximal margin



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

Compliance with ethical standards

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.

Supplementary material

Video 1

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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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Danzhu Guo
    • 1
  • Danqing Guo
    • 1
    Email author
  • Richard Harrison
    • 1
  • Logan McCool
    • 2
  • Hao Wang
    • 3
  • Brionn Tonkin
    • 2
  • Michel Kliot
    • 4
  1. 1.BayCare Clinic Pain & Rehab MedicineAurora/BayCare HealthGreen BayUSA
  2. 2.Department of Rehabilitation Medicine Division of PM&RUniversity of MinnesotaMinneapolisUSA
  3. 3.Guilford Orthopedics and Sports Medicine CenterGreensboroUSA
  4. 4.Department of NeurosurgeryStanford UniversityPalo AltoUSA

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