Kraus Back and Neck Institute in Houston, TX

Relief from Lower Back and Neck Pain

surgery optionsavoid surgery
      At the Kraus Back and Neck Institute (KBNI), we specialize
                 in non-surgical as well as surgical treatments
                                of Back and Neck  Pain
     Conservative to Surgical Options: MINIMALLY INVASIVE SPINE SUGERY 
 "Applying Science to the Art of Medicine"                                                  
                 Dr. Kraus is available for Neurosurgery consultation (surgical and non-surgical) in Houston.
                      Offices:  1) West Houston Medical Center
                                    2) Memorial Hermann Memorial City Hospital
                                    3) Katy
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      To arrange  an appointment, call 281-870-9292,  visit
or   send an e mail
              For national and international patients, we can help with  travel arrangements
                                         top doctors houston texas 2007 top docs united states neurosurgery spine   top doctors houston texas 2008 top docs united states neurosurgery spine  top doctors houston texas 2009 top docs united states neurosurgery spine   best doctors in america, united states neurosurgery spine
                                            Dr. Kraus is honored to be listed in
                                            "Best Doctors in America" (2001-2008) and
                                             "Top Doctors of Houston, Texas" (2007, 2008, 2009)     

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spinal cord stimulation and reflex sympathetic dystrophy (rsd)


What is reflex sympathetic dystrophy (RSD)?

RSD is a much debated clinical condition.  It ranges in severity from moderate to severs.  It generally affects patients who have suffered trauma, often minor, to a specific anatomic area.  Sometimes, patients won't even remember a specific injury.

Four criteria for RSD:

  • diffuse pain in an area not corresponding to the distribution of a peripheral nerve
  • diminished function of the affected area
  • stiffness of the involved joints
  • characteristic skin and soft tissue changes
    • early changes
      • swelling
      • rubor
      • hyperhidrosis (increased sweating)
      • warmth
    • late changes
      • atrophy
      • stiffness
      • coldness
      • bone demineralization


Three clinical stages (corresponding to the physical changes seen over time, as the disease progresses)

  • Stage I  (early or acute)

    • constant intense, burning pain disproportionate to the injury
    • accompanied by vasomotor instability, edema, swelling
  • Stage II (intermediate or dystrophy)

    • skin sensitivity
    • shiny or discolored skin
    • ridged or cracked nails
  • Stage III (late or atrophy)

    • wasting
    • atrophy of skin and subcutaneous tissues
    • joint stiffness
    • osteoporosis

Causes of RSD are poorly understood

Diagnosis is primarily clinical;  there is no universally accepted test

Following are tests often ordered but not diagnostic of the condition

  • triple phase bone scans
  • thermography
  • indium scanning
  • x-ray bone densitometry

***One Common feature of RSD:  improvement in pain after blockade of sympathetic outflow to the affected anatomic area

Often the blockade is temporary (local anesthetics) or permanent (surgical or chemical sympathectomy)

Some patients experience recurrence even after permanent lesioning of sympathetic outflow

Conclusion (Kumar et al: Neurosurgery, March, 1997)

"Spinal cord stimulation is an effective treatment for the pain of RSD.  The low morbidity of this procedure and its efficacy in patients failing surgical sympathectomy suggest, in our opinion, that spinal cord stimulation is logically superior to ablative sympatholysis in the management of RSD."


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                                                medical diagnosis and treatment require a history and physical examination;  the authors
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