The Largest Clinical Case Series in Peripheral Nerve Surgery: David Kline's Legacy Beyond Metrics

Abstract

Advances in peripheral nerve surgery have relied heavily on longitudinal clinical observation and consistent operative decision-making. Over several decades, Kline et al at Louisiana State University (LSU) generated the largest and most internally coherent single-center operative experience in peripheral nerve surgery, spanning thousands of cases across diverse anatomical regions and pathologies.

To characterize the structure, scope, and influence of the LSU clinical series, focusing on publication patterns, case composition, operative decision rules, and citation behavior.

A structured author-based PubMed search was performed using the indexed query “Kline DG[Author]” (January 1, 2026). Original human clinical studies reporting operative outcomes in peripheral nerve surgery were included. Reviews, editorials, experimental studies, technical reports without outcome data, and isolated case reports were excluded. Data were synthesized descriptively without meta-analysis.

The search identified 211 records, of which 54 studies met the inclusion criteria. The eligible studies clustered within the peak publication period from the mid-1990s through the late 2000s. Case volume was dominated by brachial plexus pathology, followed by major upper and lower extremity nerve injuries. The decision-making strategy was consistently guided by intraoperative nerve action potential testing. Citation counts were modest, reached an early plateau, and were followed by sustained low-level referential citation over extended periods.

The LSU clinical series serves as a denominator-setting reference defining practical recovery limits and physiologically grounded decision rules, with enduring influence extending beyond bibliometric measures.