Indocyanine Green as a Marker for Tissue Ischemia Following Extended Operative Times in Spinal Surgery, a Proof of Concept

Introduction: Tissue ischemia is a significant risk in spinal surgeries, particularly during extended operative times. Indocyanine Green (ICG) fluorescence angiography offers a potential real-time solution for detecting tissue perfusion and preventing ischemic complications. This proof-of-concept study explores the use of ICG in extended spinal surgeries to assess its feasibility and effectiveness in detecting early tissue ischemia.

Methods: We employed ICG fluorescence angiography in three extended spinal surgeries (each exceeding six hours) to monitor real-time tissue perfusion at critical stages of the operation. ICG was administered intravenously, and tissue perfusion was assessed using near-infrared fluorescence imaging. Fluorescence patterns were recorded, and areas of decreased perfusion were noted and correlated with postoperative outcomes, including wound healing and tissue viability.

Results: In all three cases, ICG fluorescence successfully identified areas of compromised tissue perfusion during the latter stages of surgery. In one case, an area flagged as ischemic during surgery ultimately required revision due to necrosis. In contrast, areas with strong perfusion as indicated by ICG remained viable postoperatively. No adverse reactions to ICG were observed.

Conclusion : ICG fluorescence angiography is a promising tool for intraoperative detection of tissue ischemia in extended spinal surgeries. Its real-time assessment of perfusion allows for timely intervention, potentially reducing postoperative complications such as necrosis and infection. Further research with larger cohorts is needed to validate these findings and explore the broader application of ICG in spinal surgery.