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
           FILM REVIEW:  send an e mail                                       
      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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Low Back Pain, can be very debilitating.  The effects of Low Back Pain in the USA are staggering!!

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   last updated
  June 19, 2009

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Minimally Invasive Spine Surgery

Lumbar Discectomy/ Spine Fusion, Interbody Fusion/Herniated Disc


When nerves in the lumbar spine are pinched, as may occur in the case of a herniated disc or lumbar spinal stenosis, pain may radiate down the lower extremities.  This is known as lumbar radiculopathy.  In more extreme cases, weakness of the lower extremities may occur, and in more critical conditions, a patient may lose bowel and bladder control.  Sometimes, all that is needed is a discectomy surgery (minimally invasive surgery), which involves removal of the herniated lumbar disc, and some of the lumbar disc material between the vertebral bodies.  At other times, a lumbar decompressive laminectomy surgery (minimally invasive surgery)  is required for a broader decompression of the nerves.  At times, the spine may become unstable, either preoperatively as a result of injury or degeneration, or during back surgery, as a result of the extensive bone removal which is sometimes required. 

We will discuss back surgery (minimally invasive spine surgery)  which consists of a lumbar discectomy or lumbar laminectomy to relieve radiculopathy.  We will also cover surgery for lumbar spine fusion.  Much of this will be done through a minimally invasive approach.  (Images were provided by Medtronic, Inc.)

When performing a minimally invasive spine surgery (back surgery), such as a discectomy, laminectomy, spine fusion, or minimally invasive surgery, the patient is lying on their abdomen, supported in a variety of ways.  The patient may be positioned on gel rolls, or on a Wilson frame, or on an OSI or Jackson table, which are designed specifically for surgery on the spine.  For lumbar surgery, an incision is made over the lumbar spine.  The exact position and length of the incision depends upon what needs to be done.  After the incision is made, the muscles are pulled away from the spine.

Below, we see an open back (spine)  surgery, with retractors in place, pulling muscle and fat (adipose tissue) to the side, so that the lumbar spine is exposed.  An instrument is used to help with the removal of the lumbar lumbar spine surgery








A tubular dilator is passed down to the lumbar spine for the minimally invasive surgery on lumbar the spine. The bottom portion of the tubular retractor is docked on the lumbar lamina.

spine surgery through percutaneous tube

Below is the view which the surgeon has (during a minimally invasive spine surgery), with the lumbar nerve root seen.  The surgeon is performing a discectomy, which is a removal of the lumbar disc.  The view is what the surgeon would see while looking and working through the tube.

microscopic surgery of the spine



Below, a lumbar disc distractor is placed within the disc space.  This helps to maintain the height of the lumbar disc space on one side, while the other side is being prepared.

plif, tlif, lumbar interbody fusionwiltse approach to spine surgery












Pedicle screws may be placed within the pedicles of the lumbar spine, and on the opposite side, to help create a working channel.  Pedicle screws are screws which go into the pedicles, and provide a rigid and stable construct to which rods may be attached.  The rod may then be attached to a pedicle screw placed at another spinal level.

minimally invasive lumbar fusion


A rotating cutting device is placed within the disc space to clean out some of the lumbar disc material. 

cleaning disc space, minimally invasive spine surgery


percutaneous minimally invasive surgery, spine










Curettes are used to scrape the endplates of the vertebral bodies, further cleaning out the disc space.


minimall invasive surgerywiltse approach, spinal fusionwiltse approach, minimally invasive spine surgery


A rasp is used to roughen up the edges of the bone in the vertebral body, which will place the eventual intervertebral body graft in contact with healthy bleeding vertebral body. Below, on the left, this is done through an open insicion, whereas on the right, it is done through a minimally invasive approach tubular guide.  On the left, the spine surgery is being accomplished through a Wiltse approach.  The Wiltse approach involves an incision off of the midline, with dissection through the various muscle layers of the back.


wiltse approach, minimally invasive spine surgeryminimally invasive surgery of the spine



Below, we see a minimally invasive retractor in place.  On the right is an x ray of a disc distractor in place, and pedicle screws and a rod are seen.

minimally invasive spine surgeryminimally invasive spine surgery, back surgery










Below, a trial is performed to find the appropriate sized intervertebral body implant.  This allows the surgeon to find the appropriate graft for the placement of a posterior lumbar interbody fusion (PLIF).  A PLIF is a graft placed between the vertebral bodies, which will allow one body to fuse to the adjacent one.


interbody graft, spine fusionlaminectomy, spine surgery, minimally invasive surgeryminimally invasive spine surgery, interbody graft



Next, the intervertebral cage is deployed into the intervertebral disc space.  Bone graft is packed around the cage.

interbody fusion, graft, plif, tlif, pedicle screws


Pedicle screws are placed on both of the lumbar spine, to assist with the spine fusion.

plif, interbody fusion, pedicle screws


Pedicle screws and rods are placed on both sides, to promote lumbar spine fusion.


pedicle screws, spine surgeryplif, pedicle screws, interbody fusion















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