Our History
Written by Stephen Hochschuler, M.D.

We participated in the clinical trials of the first two threaded fusion cages, the BAKTM and the Ray TFCTM. Personally, I was concerned as to how one of these cages would be extracted if it became infected. There was also some concern about the potential for subsidence of the metal cages into the vertebral bodies.

In our research foundation, we tested the first cylindrical threaded femur bone. This was presented to the North American Spine Society in a poster presentation in 1992, and several years later this technology was picked up by the Florida Bone Bank. They manipulated the technology somewhat and came out with a femur bone dowel that was thereafter marketed by Medtronic.

Due to concerns of the threaded metallic cages cutting into the toughest part of the bone, the endplates, we worked with Spinal Concepts to design a product called InFix. It basically rests on the endplates and preserves lordosis, while avoiding the potential complication of poisoning a cylindrical cage too deeply and perhaps hitting the nerve root. This product has recently received FDA approval for vertebroplasty systems.

In 1992, we became very interested in the artificial disk and invited Dr. Karin Büttner-Janz, co-inventor of the first total disc replacement, to visit the Texas Back Institute. We were intrigued by the fact that surgeons in the United States continued to do fusions the spine and yet in regard to the hip and knee, this was not the case. Fusions had become passé and people were replacing hips and knees. Consequently, we worked with Dr. Büttner-Janz to translate text related to the development of the prosthesis from German to English and to publish this with her in the United States. Almost ten years later we were able to work with the Link Company to start the FDA clinical trial on the Link SB Charité prosthesis. Almost simultaneously, we were the initial site for the investigation of the Spine Solution’s ProDisc.

Our goal approximately four years ago was to become one of the major arthroplasty spine centers in the world, and consequently, we have been very active in the whole arthroplasty realm. We do this not just for the sake of doing things, but it truly keeps our level of interest high in regard to the intellectual challenge of development of the science of spine and to ultimately improve care for back pain patients.

Texas Back Institute is presently focused on five major areas for downstream development of the science of the spine:

• Arthroplasty, which is subcategorized to total disc replacement, nuclear replacement, annular repair, extraligamentous repair, and facet joint replacement.
• Minimally invasive surgery of the spine
• Image guidance and robotics
• Genetics and biomaterials
• Nanotechnology and MEMS (microelectromechanical systems)

We have positioned relationships with various academic and private institutions to maximize our knowledge in these realms.


The more we do the more we help.

Recently, Innovative Spinal Technologies a for-profit organization was formed to enable us to rapidly develop and deploy new and leading edge technology.

Early on, Texas Back Institute became in telemedicine, and we actually have one of our offices in Midland, Texas, connected to our main hub office in Plano, Texas. This has enabled us to treat patients in a remote location with the real time audio, video and data. Being concerned about the patient’s acceptance of the technology, we did a study and found that the patients were very comfortable with the system. Our goal is to expand telemedicine into a regional, national and international endeavor.

In 1992, Fortune Magazine featured Texas Back Institute in a five-page spread. As a result, Dr. Reggie Herslinger, a professor at Harvard Business School, sent three of her MBA fellows to study as the focus factory in spine, similar to the Scholdeis clinic for hernias or certain cancer institutes that deal with a narrow niche but are integrated vertically.

Integrating multiple specialties within Texas Back Institute has been a labor of love, but not easy. There are always turf battles. When we brought in an exercise physiologist, the physical therapists did not accept him. It became a process of slow integration. When we elected to bring in chiropractors, we had turf battles and much concern. The way we have successfully gotten around this has been by doing it slowly, bringing in the best of the breed, and consequently having the opportunity to have members of our group learn from these distinguished people in their own realms.

At this point, we have integrated within Texas Back Institute neurology, occupational medicine, physical medicine and rehabilitation, physical therapy, occupational therapy, nursing, psychology, exercise physiology, chiropractic, orthopedic spine surgery, general surgery and internal medicine. In the past we have had neurosurgical integration; however, at this point, we do not have a neurosurgeon on staff although we do work with two neurosurgeons on an as-needed basis.