The case library — de-identified imaging

The work, on film.

A decade of the state's hardest spine cases — shown the way surgeons see them. Every operation below was performed by Dr. Pugely, start to finish.

All imaging has been de-identified and screened for patient information. These are representative cases illustrating the scope of the practice — every spine is different, and imaging shown does not predict any individual outcome.

Series 01

Adult deformity & scoliosis reconstruction.

The signature of this practice: full-length standing analysis, alignment measured to the millimeter, and long-segment correction anchored to the pelvis when the case demands it.

Standing AP X-ray of untreated adult scoliosis — **The presentation** — untreated adult scoliosis, standing AP

Pre-operative standing AP X-ray showing coronal collapse — **One patient, before** — coronal collapse, standing AP

Post-operative standing AP X-ray, long construct to the pelvis — **Same patient, after** — long construct to the pelvis, standing AP

Pre-operative standing lateral X-ray — **One patient, before** — sagittal alignment, standing lateral

Post-operative standing lateral X-ray, alignment restored — **Same patient, after** — alignment restored, standing lateral

Post-operative standing AP of thoracolumbar-to-pelvis construct — **The correction** — thoracolumbar-to-pelvis construct, standing AP

Post-operative standing lateral of long construct — **The correction** — same case, standing lateral

Post-operative standing AP of long-segment reconstruction — **Restored balance** — long-segment reconstruction, standing AP

Post-operative standing lateral of long-segment reconstruction — **Restored balance** — same case, standing lateral

Standing full-length X-rays showing sagittal imbalance — **The workup** — standing full-length films, sagittal imbalance

Standing X-ray of adult degenerative scoliosis — **The presentation** — adult degenerative scoliosis

Pre-operative standing AP film of scoliosis — **The presentation** — coronal deformity, standing AP

Before and after X-rays of thoracolumbar-to-pelvis reconstruction — **One patient, before → after** — thoracolumbar-to-pelvis reconstruction

Post-operative standing AP of long-segment correction — **The correction** — long-segment construct, standing AP

Post-operative lateral X-ray with alignment measurements — **Measured discipline** — lateral with alignment parameters

Post-operative AP of thoracolumbar instrumentation — **The correction** — thoracolumbar instrumentation, AP

Post-operative lateral of long construct — **Restored balance** — lateral, long-segment construct

Post-operative AP of long construct — **Restored balance** — same case, standing AP

Lateral X-ray of kyphosis correction — **Kyphosis correction** — lateral, post-operative

AP X-ray of long construct with pelvic fixation — **Anchored to the pelvis** — long construct with pelvic fixation

Full-body standing EOS imaging of complex reconstruction — **Full-body standing alignment** — complex multi-segment reconstruction

Series 02

Complex cervical reconstruction.

Top-5%-in-Iowa volume in cervical spine surgery — from cord decompression to multi-level posterior reconstruction.

Lateral X-ray of cervical fixation — **The construct** — cervical fixation, lateral

MRI showing cervical spinal cord compression — **The diagnosis** — MRI, cervical cord compression

Lateral and AP X-rays of cervical reconstruction — **The reconstruction** — lateral + AP, posterior instrumentation

Lateral X-ray of posterior cervical construct — **Occiput to thoracic** — lateral, posterior construct

AP X-ray of posterior cervical construct — **Occiput to thoracic** — same case, AP

Series 03

Lumbopelvic & sacral fixation.

When the base of the spine fails — high-grade instability, sacral fracture, failed prior fusion — the fix has to hold where bone quality is worst and forces are highest.

AP pelvis X-ray showing lumbopelvic fixation — **The foundation** — lumbopelvic fixation, AP pelvis

Sagittal CT of lumbopelvic instrumentation — **Verified in section** — sagittal CT, lumbopelvic hardware

Series 04

Under the surface.

Advanced imaging drives every decision — where the nerve is pinched, whether the fusion has healed, exactly where the correction must come from.

Lumbar MRI showing spondylolisthesis and stenosis — **Where it starts** — lumbar MRI, slipped vertebra pressing the nerves

Sagittal CT reconstruction with spinal hardware — **Healing, verified** — sagittal CT through the construct

The work, on film.

Seven cases, start to finish.

Adult deformity & scoliosis reconstruction.

Complex cervical reconstruction.

Lumbopelvic & sacral fixation.

Under the surface.

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