Our History
Written by Stephen Hochschuler, M.D.
• Introduction
• Lessons
Learned
• Research
Foundation
• New
Programs
• Clinical Trials/New Technology
• New
Challenges
Under the leadership of Dr. Richard Guyer, the Texas Back Institute
Spine Surgery Fellowship program was initiated in 1986. Currently,
Dr. Guyer and Dr. Jack Zigler are directors of the fellowship.
To date, we have trained 54 surgeons from all over the United States.
The creation of the fellowship sparked the development of our weekly
Neuroscience conference, which is CME accredited. The fellowship
program also includes a weekly interesting case conference and
a monthly journal club. In addition to the formal twelve month
fellowship program, we have visitors from all over the world who
come to observe the latest technology being developed in the United
States.
In addition to the back school, we have also initiated other patient
education programs. Approximately 15 years ago we developed a series
of ten videotapes. In most operative procedures
we perform, the patient is educated pre-operatively by watching
the tapes with a nurse clinician. After viewing the tapes the Nurse
will answer any questions the patient may have. Naturally, the surgeon reviews the proposed surgery with the patient
as well and answers any questions that still may linger.
More recently we have created an automated, interactive informed
consent process. The patients view high-quality computer graphics
accompanied by text and audio. At the end of the program, the patient
is asked to respond to questions concerning their understanding
of the risks related to the surgery; verifying that all their questions
have been answered to their satisfaction; and giving their consent
to the surgery. All the responses are automatically documented,
signed and placed in the chart. A nurse educator is available throughout
the process to answer questions.
We have authored numerous books for the lay public including Back
in Shape and two editions of Treat Your Spine without Surgery.
In addition, we have been on public television and have participated
in educational symposiums for the public. Our goal has been to
utilize all the new information technology potential for educating
patients. We are involved in both Spine University and Spine-Health
and have been integral in preparing content as well as helping
to develop these websites.
Texas Back Institute has been involved every step of the way in
regard to new product development. The initial pedicle screw and
rod fixation system developed was first conceived by Dr. Ralph
Rashbaum on a napkin that he gave to Dr. Art Steffee of Acromed.
Dr. Steffee called this first construct the Texas Connection. Since
that time, many other systems have evolved.
It should be noted that from 1980 to 1981 we played a role in the
formation of bone banks. The initial concept for cross sections
of femur bone to be used in anterior lumbar inter-body fusion is
something I had taken to Osteotech.
One problem we encountered with this bone was that it was somewhat
eburnated, and the concept thereafter was to cross hatch the bone
with tire treads and see if this would help. Unfortunately, it
did not make much difference, and Dr. Steffee and I considered
using a curved nail that would go from the superior vertebral body
through the medullary canal of the femur bone into the vertebral
body below. This seemed a little difficult, and Dr. Will Smith
from Atlanta had the idea of using a screw in front of the graft
that would serve as a doorstep. This turned out to be the simplest
solution and consequently has been incorporated since then.
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