Our History
Written by Stephen Hochschuler, M.D.
• Introduction
• Lessons
Learned
• Research
Foundation
• New
Programs
• Clinical Trials/New Technology
• New
Challenges
Along the way we learned many lessons. In the early days of the
Texas Back Institute, very few diagnostic techniques were available
for evaluating a person with back pain. As in most specialties,
one relied heavily on the information given by the patient in addition
to the physical examination that followed.
When Texas Back Institute first started, oil soluble myelography
was the only thing available. It was not until several years later
that water-soluble myelography became available. Initially, we
had to do all of our own diagnostic and therapeutic procedures
such as myelography, facet joint injunctions, facet blocks, selective
nerve injections. The only implants available at that time were
Harrington instrumentation or what was coming onto the scene called
Knodt rods. We felt obligated to implement new protocols for conservative
care and physical therapy, as well as new surgical approaches to
the spine.
Texas Back Institute became the second center in the United States
to do multi-planar reconstruction of CT scans. We visited with
Dr. William Glenn in California who initiated the entire process.
We learned much along the way from physical therapists including
Dr. Stanley Paris and Robin McKenzie. We adopted their protocols
early on and have used their treatment procedures throughout the
history of Texas Back Institute. Other physical therapy procedures
have been incorporated as we progressed.
In San Francisco we visited Dr. Art White, who developed the first
back school in the United States. We rapidly incorporated this
treatment concept into our program and became the second back school
in the United States. We had a 12-hour back school program, and
we charged only $120. The program was taught by a physical therapist,
an occupational therapist, a psychologist and a surgeon.
Blue Cross Blue Shield met with us and was not only impressed with
our program, but also questioned our ability to charge such a nominal
fee. We related that we would not make money on the program and
that our primary mission was to help the patient as well as differentiate
Texas Back Institute from other facilities in the market.
When we approached Blue Cross Blue Shield about covering our procedures, they
stated that although they were impressed, they would not cover it since CPT codes
had not yet been established. This situation is not unique in healthcare; often,
insurance carriers are reluctant to embrace new technology in the market
As things progressed, we became the first institution in the country to prescribe
outpatient myelography. By the time we launched this program, we had, unfortunately
already lost two of our best nurse practitioners because they felt this practice
could be a liability. As is the case with insurance carriers, providers are,
at times, just as hesitant to accept new procedures or technology. However, technology
has come a long way and today, myelograms are performed on an “out patient” basis,
as are most spine related procedures.
We were also asked to help on the development of the MRI scan. We worked with
Dr. Ken Miravela from The University of Texas Southwestern Medical School at
Dallas, and also had multiple discussions with Dr. Leon Wiltse in California.
Although the initial impression was that it was very difficult to get an image
that was of any value, MRI subsequently has turned out to be the study of choice.
Along the way, we became very interested in discography. We published a paper
on the Dallas discogram description along with Dr. Dave Selby, and this became
a battle due to the fact that people were vehemently divided as to this procedures
true value. To this day, it is still controversial depending on who you speak
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