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case_images: Case 1: pre- versus postoperative standing X-rays. Preoperative AP (A) and lateral (B) standing scoliosis X-rays showing a coronal deformity, a mild sagittal imbalance, and a loss of lumbar lordosis. Postoperative AP (C) and lateral (D) images showing an improved coronal deformity, lumbar lordosis, and a sagittal imbalance.
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case_images: A 71-year-old female with a history of prior L2 to S1 spinal fusion presented with mechanical back pain and a sagittal plane deformity from proximal junctional kyphosis, as well as preoperative imaging suggestive of pseudoarthrosis (Figure 1).
case_images: ICG perfusion of the thecal sac and deep muscles. (A) Post-ICG injection image showing good fluorescence of the thecal sac (*). (B) Post-injection image showing fluorescence of the muscle flap (arrow) with minimal perfusion deficits.
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case_images: ICG showed minimal tissue ischemia intraoperatively and good perfusion of the deep muscles and thecal sac (Figure 2).
case_images: Intraoperative images showing (A) white-light and (B) ICG views of the operative field. There are no clear differences in tissue appearance in the white-light image. However, under ICG fluorescence, there were areas of tissue that did not fluoresce.
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case_images: Notably, white light showed no clear visual differences between the florescent and non-florescent tissues, unlike ICG (Figure 3).
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case_images: Case 2: pre- versus postoperative MRI. (A) Preoperative T1 post-contrast MRI showing enhanced T9-T12 extradural mass. (B) Postoperative T1 fat-sat post-contrast MRI showing removal of the enhanced tumor. (C) AP and (D) lateral chest X-rays showing the placement of the carbon-fiber pedicle screws and rods.
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case_images: He underwent complete resection of the tumor, decompression, facetectomies, pediculotomies, and instrumented fusion (Figure 4).
case_images: Deep-muscle perfusion with peripheral ischemia. (A) Black and white ICG imaging showing small areas of perfusion defects, as indicated by the ROI box showing 7% relative fluorescence. (B) Color-scaled imaging showing good perfusion of the underlying muscle flaps (white ROI box showing 57% fluorescence), indicated in red, with some areas of deficit indicated in blue.
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case_images: ICG showed good deep-muscle perfusion with tissue ischemia only along the periphery of the wound (Figure 5).
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case_images: Case 3: pre- versus postoperative imaging. Preoperative T1 post-contrast (A) and T2 (B) MRI showing the left-sided L4 nerve sheath tumor as indicated by white arrow. (C) Postoperative X-ray showing L4-pelvis instrumentation after nerve sheath tumor removal.
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case_images: The patient underwent tumor resection, high hemi-sacrectomy, iliac osteotomy, and instrumented fusion (Figure 6).
case_images: The non-fluorescence of the gluteal muscle flap. Post-ICG injection black-white imaging showing two segments of the gluteal flap. Segment (A) showed good fluorescence, white segment (B) showed no fluorescence after the supplying artery was coagulated.
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case_images: ICG intraoperatively showed a completely non-fluorescent flap of gluteal muscle after the required lateral dissection interrupted the arterial blood supply (Figure 7).
case_images: Postoperative MRI indicating asymmetric tissue perfusion. Postoperative MRI scans demonstrating asymmetry in contrast filling (white arrows), suggestive of a possible mismatch in tissue perfusion. The left image reveals reduced perfusion in the postoperative bed, while the right image shows more uniform perfusion. The asymmetry indicated by the arrows may reflect tissue ischemia or a compromised postoperative blood supply.
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case_images: A postoperative MRI showed a potential perfusion defect in the muscle (Figure 8).