Dr. Stephen Hochschuler and the formation of Texas Back Institute

Written by Alan Condon | August 14, 2019 | Print  |

In Wichita Falls, Texas in 1971, two general medical officers — Stephen Hochschuler, MD, and Ralph Rashbaum, MD — met each other for the first time while stationed in the U.S. Air Force. 

Dr. Hochschuler had three years of training in general surgery under his belt from Harvard Medical School in Boston, while Dr. Rashbaum completed two years of general surgery training at Strong Memorial Hospital in Rochester, N.Y. 

Neither physician began plying their trade as an orthopedic spine surgeon but six years later, they would start to assemble the first pieces of the Plano-based Texas Back Institute; an independent multidisciplinary academic spine practice. 

Drs. Hochschuler and Rashbaum were serving in the military under the Berry Plan, a Vietnam War-era program that allowed physicians to defer obligatory military service until they completed medical school and residency programs. As Dr. Hochschuler rotated through various specialties in the Air Force, he realized two things: he thoroughly enjoyed orthopedics and nobody seemed to have an answer for back pain.

"This was an area that one could really help society because seven out of 10 Americans get back pain, of which the vast majority should be treated conservatively, not surgically," said Dr. Hochschuler.

"Years before there was not a clear definition as to the cause of abdominal pain. Was it a ruptured appendix, a gall bladder problem, intestinal torsion or multiple other diagnoses? Likewise, at the time no clear etiology existed as to whether back pain symptoms were facet pain, discogenic pain, muscle pain or what was the cause of radicular pain," he said.

Definitions of these conditions would later evolve but at the time hardly anyone was focusing on spine. Spinal stenosis was only beginning to be described and conditions such as internal disc derangement did not exist due to the lack of diagnostic techniques, according to Dr. Hochschuler.

"There were also questions concerning whether one could get pain secondary to soft tissue, such as ligamentous hypertrophy as compared to disc herniation, or some other tissue abnormality," he added.

After completing military service, both physicians began orthopedic residencies — Dr. Rashbaum at the University Hospital of Cleveland and Dr. Hochschuler at Dallas-based University of Texas Southwestern Medical School and Parkland Memorial Hospital. 

They managed to stay in touch post-residency as Dr. Rashbaum pursued a fellowship under the tutelage of the late Henry Bohlman, MD, and another under Richard Rothman, MD, PhD, who passed away late last year. Dr. Hochschuler went on to develop the spine program at the Department of Veteran Affairs hospital at UTSMS. 

In 1977 Dr. Hochschuler convinced Dr. Rashbaum to move to Texas to create a spine institute. The objective was to integrate a multispecialty model for spine care that included prevention, conservative care, surgical care, rehabilitation, research and development.

"We wanted to do everything from ergonomic analysis, industrial back school and prevention through to fellowship training, research, new product development and everything in between," said Dr. Hochschuler. 

In 1982 Richard Guyer, MD, became Texas Back's third founding partner and the institution entered a new phase of growth. In 1986, under Dr. Guyer's leadership, the spine surgery fellowship program was established, which has since trained over 108 spine surgeons across the U.S.

Texas Back has evolved into 11 offices in north Texas with 20 spine surgeons and another 20 physicians across various specialties including physical medicine, anesthesiology, dolorology, internal medicine and psychology.

Dr. Hochschuler stopped operating two years ago but remains chairman of Texas Back Institute Holdings Corporation. Now his attention is fixed on innovative ideas, new companies, biologics and telemedicine. 

"I think to stay healthy, it's not just about staying physically active and dieting, you've got to keep your mind going," he said. "So as long as my mind can function, I'll die with my boots on."

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