Iowa Back Institute · Case Library
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The case library

Read the films. Then read the plan.

Real cases from Dr. Pugely's practice, shown the way surgeons show them — imaging first, minimal narration. Two of the seven never needed an operation. That's part of the point.

07
Cases in the library
02
Treated without surgery
All
Imaging de-identified
Back injury at work — no surgery needed — de-identified spine imaging TREATED WITHOUT SURGERY
C-01
Back injury at work — no surgery needed
44-year-old man, low back pain after a twisting injury at work. No prior back trouble, no leg pain, no red flags.
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L5-S1 disc herniation — resolved without surgery — de-identified spine imaging TREATED WITHOUT SURGERY
C-02
L5-S1 disc herniation — resolved without surgery
48-year-old man, work lifting injury three weeks earlier. Severe back and leg pain with weakness — admitted because he couldn't walk.
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L5-S1 microdiscectomy after conservative care failed — de-identified spine imaging LUMBAR DISC
C-03
L5-S1 microdiscectomy after conservative care failed
34-year-old man, lifting injury shoveling stone. Severe back and leg pain — three months of therapy, medications, and injections without relief.
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C5-C6 artificial disc replacement — de-identified spine imaging CERVICALPRE / POST
C-04
C5-C6 artificial disc replacement
25-year-old man, work-related lifting. Severe neck pain, tingling and numbness, with right-arm weakness — three months of conservative care without relief.
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L1 fracture from a fall — fusion with cage — de-identified spine imaging TRAUMAPRE / POST
C-05
L1 fracture from a fall — fusion with cage
32-year-old scaffolding construction worker, fall from height. Severe low back pain and weakness — CT shows an L1 fracture with bone pushed into the canal.
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Revision fusion for adjacent-segment disease — de-identified spine imaging REVISION & COMPLEXPRE / POST
C-06
Revision fusion for adjacent-segment disease
54-year-old woman, fused at L3-L4 in 2007. Pain persisted — years later, MRI shows the level next to the old fusion wearing out.
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T9-to-pelvis reconstruction after failed fusion — de-identified spine imaging REVISION & COMPLEXPRE / POST
C-07
T9-to-pelvis reconstruction after failed fusion
62-year-old woman, prior L5-S1 fusion. Pain kept worsening; a spinal cord stimulator was placed and didn't control it. Therapy and medications failed.
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All cases shown are real patients treated by Dr. Andrew Pugely, presented with de-identified imaging for education. Every spine — and every recovery — is different: individual results vary, and nothing on this page is a guarantee of outcome or a substitute for an in-person evaluation.
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Complex, revision, and workers' compensation spine referrals are seen quickly — call the office or start with the workers' comp team.
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