Spine Talk

One of the most remarkable advancements in medical technology and spinal treatment occurred more than 20 years ago. At the request of the Federal Drug Agency (FDA), leading spine surgeons at selected practices around the United States began exploring the feasibility of replacing damaged vertebral discs with those that were man-made. An artificial disc is an elegant concept because it restores motion between the vertebral bodies instead of fusing them to other discs and locking them in place. However, improving on what Mother Nature “created” is always a challenge. Fortunately, the spine specialists at Texas Back Institute (TBI) were up for the task. To see the full article visit: www.texasback.com/blog #discreplacement #Artificialdiscreplacement #backpain #Neckpain #spinecare #richardguyer #scottblumenthal #jessicashellock #texasback

How to Enjoy Snow Skiing While Protecting Your Back and Neck If you're planning a downhill snow skiing trip this winter, Dr. A.J. Rush III, an avid skier and orthopedic spine surgeon with Texas Back Institute, has some suggestions on how to enjoy the mountains while protecting your back and neck... Read the rest of the blog here:https://texasback.com/how-to-enjoy-snow-skiing-while-protecting-your-back-and-neck/

Some may argue on the surface they don't have much in common, as martial arts are typically used for self-defense or attack, where as medicine is used to heal and care for patients. But, when talking with Dr. Jessica Shellock, Orthopedic Spine Surgeon and Dr. Sheena Bhuva, Physiatrist, about their life in medicine and the martial arts there is much more in common between the practices. Learn more at www.texasback.com

Read the full blog here: https://texasback.com/concern-about-concussions-at-the-draft-combine-what-nfl-players-have-taught-us/ Many athletes have sought expert medical attention from Texas Back Institute and two exemplary neurosurgeons, Dr. Akwasi Boah (https://texasback.com/find-a-physician/name/akwasi-boah/) and Dr. Thomas Kosztowski (https://texasback.com/find-a-physician/name/thomas-kosztowski/) These two neurological experts recently offered insights on the diagnosis and treatment of concussions. Every year, the National Football League (NFL) stages its annual “Draft Combine,” where highly regarded college players undergo medical examinations and perform drills for teams that might consider drafting them in the spring. This week-long event also serves as an opportunity for league officials and medical specialists to update the teams and the public on the state of prevention and treatment of NFL players from injuries suffered in games and in practices. Since the 2017 season, the league has instituted several rule changes and on-field concussion protocols. A spokesman for the NFL said that the league is particularly interested in whether key rule changes, such as banning the lowering of the helmet to initiate contact and eliminating blind-side blocks, has reduced injuries. In the not-so-distant past, having a concussion was perceived as an “occupational hazard” for professional football players and many players ignored the risks of these injuries. Now, athletes in all sports and at all levels - middle school, high school, college and professional, are concerned about the health risks of head injuries.

Read the full blog here: https://texasback.com/the-future-of-spine-surgery-will-involve-3d-printing/ There is an interesting intersection at work between the disciplines of mechanical engineering and orthopedic surgery. For example, spine surgeon Dr. Michael Hisey of Texas Back Institute earned his undergraduate degree in mechanical engineering from The California Institute of Technology. Of course, he then went on to medical school and specialized in orthopedic surgery, but his fascination with engineering continues to this day. This partially explains his interest in the 3D printing of medical devices. A Brief History of 3D Printing While it seems that 3D technology has just recently burst on the scene, in fact, it has been around since 1981. It was originally known as “additive manufacturing” and was invented by Hideo Kodama of Nagoya Municipal Industrial Research Institute in Japan. The first medical application of 3D printing occurred in 1999 when scientists at Wake Forest Institute for Regenerative Medicine printed synthetic scaffolds of a human bladder and then coated them with the cells of human patients. The newly generated tissue was then implanted into the patients with little to no chance that their immune systems would reject them, as they were made of their own cells. The market for 3D printing is growing rapidly. One example of this growth is Essentium Inc., a Texas-based 3D printing company that is transforming additive manufacturing for use in a broad range of industries. Read the full blog here: https://texasback.com/the-future-of-spine-surgery-will-involve-3d-printing/

Dr. Scott Blumenthal (https://texasback.com/find-a-physician/name/scott-blumenthal/) joins the podcast to talk about Artificial Disc Replacement Surgery, how the technology has evolved since he helped bring it to the United States nearly 20 years ago, and what can be done for the small percentage of patients that may need a revision surgery. Find more information about Total Disc Replacement athttps://texasback.com/treatments/surgical-treatments/fusion/tdr/ Join us at: https://www.facebook.com/texasbackinstitute/ Follow the conversation: https://twitter.com/TexasBack Watch More at: https://www.youtube.com/texasbackinstitute

Read the Full story here: https://texasback.com/how-a-new-treatment-for-adhd-might-offer-relief-for-epilepsy/ There’s new hope for those who suffer from the debilitating condition of epilepsy. A minimally invasive procedure recently approved by the U.S. Food and Drug Administration (FDA) for treating Attention Deficit Hyperactivity Disorder (ADHD) in children holds promise for helping the 65 million people suffering from epilepsy. One of the neurosurgeons who helped evaluate this new treatment for the FDA is a member of the team of specialists at Texas Back Institute – Dr. Thomas Kosztowski. Do you or a loved one suffer from epilepsy? Have you seen symptoms of this condition and are concerned about treatment? Schedule an appointment with Dr. Kosztowski or other neurosurgeons at Texas Back Institute. Read the Full story here: https://texasback.com/how-a-new-treatment-for-adhd-might-offer-relief-for-epilepsy/

Dr Michael Hisey Talks Sciatica - Symptoms And Treatments by Texas Back Institute

Dr. Rey Bosita talks about Swimming And Diving Injuries and How to Avoid them. by Texas Back Institute

Read the full story here: https://texasback.com/why-this-texas-doctor-received-physician-of-the-year-honors-for-life-changing-work-halfway-around-the-world/ A selfless spine specialist at the renowned Texas Back Institute travels halfway around the world every year with a team of dedicated volunteers to Ethiopia to perform some of the most complex spine surgeries in the most challenging of circumstances. For his relentless pursuit of life-changing surgery to patients who are critically disabled with spinal deformities such as scoliosis, Dr. Ted Belanger was recently named 2018 Medical Missions.Org Physician of the Year. In typical fashion, Dr. Belanger was humbled by the international honor. “I was nominated by a colleague for this award for the work I have been doing for the last nine years,” Dr. Belanger said. “I have an annual mission to Ethiopia where I perform free spine surgeries, primarily for advanced spinal conditions and deformities such as scoliosis, and treatments for tuberculosis, traumas and infections. We have also been fortunate enough to bring some patients from Africa to the United States who needed more extensive procedures. “Since 2010, when we started this mission, we have done surgery on more than 125 patients in Ethiopia. Plus, we have transported five other patients to this country for procedures. “The committee from Medical Missons.Org felt that these actions qualified for the “Physician of the Year” award and I am humbled by their decision.” Read the full story here:https://texasback.com/why-this-texas-doctor-received-physician-of-the-year-honors-for-life-changing-work-halfway-around-the-world/

Dr. Rey Bosita, Orthopedic Spine Surgeon at Texas Back Institute talks about herniated discs, and the symptoms that you need to watch for. What is a herniated disc? Between each bony vertebral body is a disc that acts as a shock absorber and a hinge. As we age, the disc becomes dehydrated, making it less supportive and more prone to injury. Even a healthy, well-hydrated disc can be injured. The disc is composed of the annulus, which is a tough tissue that makes up the outside of the disc. The nucleus pulposus is the jelly-like substance contained in the center of the disc. A herniated disc occurs when the nucleus breaks through the outer tissue. A herniated disc is very common and may or may not cause symptoms. Stretching or tearing of the annulus may result in back or neck pain. The discs are immediately in front of the spinal cord and exiting nerves, so when the herniated disc or protrusion compresses the spinal cord or nerves, leg or arm pain and numbness or weakness may occur. Find more here: https://texasback.com/conditions/herniated-disc/

Dr. Ted Belanger talks about Spinal Instability in this short, but informative podcast. Spinal Instability is described as excessive motion of vertebral bodies in relation to one another is considered spinal instability. Some motion is, of course, normal. Motion can be described as instability when the motion is significantly greater than that at adjacent levels. Spinal instability can be the result of an injury, degenerative process, tumor, previous surgery or congenital condition. Symptoms of spinal instability may include neck or back pain, nerve pain and muscle spasms. Find More here: https://texasback.com/conditions/spinal-instability/

Dr. Thomas Kosztowski Talks About The Common Causes Of Neck Pain by Texas Back Institute

View the full story here: https://texasback.com/are-you-taking-too-much-ibuprofen-for-your-constant-pain-the-answer-is-most-likely-yes/ Whether it is chronic or acute, pain affects the quality of life of millions of Americans every day. Pain varies in severity, based on its cause and other factors. It is felt when special nerves that detect tissue damage send signals to transmit information about the damage along the spinal cord to the brain. Literally, billions of dollars are spent each year by consumers who are trying to "interrupt" this signal with non-prescription, over-the-counter (OTC) medications. The Consumer Healthcare Products Association estimates that more than 2.9 billion retail trips are made each year for OTC medications and the average U.S. household spends about $338 per year on these non-prescriptive drugs. Among the most popular of these OTC medications are those that are used to treat pain These includes Ibuprofen, such as Advil® and Motrin ® and acetaminophens, such as Tylenol® View the full story here: https://texasback.com/are-you-taking-too-much-ibuprofen-for-your-constant-pain-the-answer-is-most-likely-yes/

Dr. Scott Kutz (https://texasback.com/find-a-physician/name/scott-kutz/) , a neurosurgeon at Texas Back Institute (https://texasback.com/treatments/surgical-treatments/fusion/tdr/spinal-cord-stimulation-scs/), treats hundreds of patients each year for back pain and has some first-hand experience with spine stimulation. “The original spine stimulators were developed in the 1960s,” he said. “However, the technology could not be used in a wide-spread fashion until the 1980s. This was because the pacemaker technology, which, like the spine stimulator, could be implanted and maintain electrical stimulation for a long period of time, improved at this time “Between the 1980s and 2010, the technology was relatively static. There was a certain recognized range of stimulation frequency that could be delivered to the dorsal column of the spinal cord. If the stimulation was delivered within those parameters, the patient would typically get a reduction of pain, particularly pain to the hips, buttocks, shoulders, some parts of the back, arms and fingers. “Unfortunately, some patients did not get good pain reduction from this type of stimulation. This could be due to the fact that they might have more pain centered in the neck, at the back of the head or in the lumbar spine area. In some cases, the patients would experience paresthesia with this stimulation, meaning they could feel this stimulation and for many that sensation was disagreeable. It was annoying to some patients, and this made it ineffective in coverage of the pain. “We now have high-frequency stimulation that cannot to be perceived by humans. Thus, when this stimulation is delivered, it still has effects on the nervous system and still interrupts pain delivery from those distal nerves up to the brain, but it is not perceived by the patient. This means the stimulation can cover deeper pathways within the spinal cord leading to better coverage of pain in the neck itself, the thoracic area (where the ribs attach to the spine) and the lumbar (lower back) area of the spine.” Using Stimulation Instead of Opioids The fact that this new version of spine stimulator is being used instead of opioids for treatment of back pain is good news for the medical community, which is concerned about their abuse. From a medical standpoint, how does spine stimulation mimic the effect of opioids for the treatment pain? “Actually, spine stimulation and opioids work differently on pain,” Dr. Kutz said. “Opioids don’t eliminate pain but rather they increase the tolerance of the mind to having pain. Most patients who are taking opioids say things like, ‘I can still tell that I hurt, but I just don’t care.’ “With spinal cord stimulation, there is an actual disruption of that pain signal coming up to the brain.” Visit Texasback.com/blog for the full story.

Read the full article at www.texasback.com/blog New Research: An Imaging Biomarker Could Change Treatment of Degenerative Disc Disease There is promising news for millions of patients who suffer from lower back pain and disability caused by degenerative disc disease. Researchers in Hong Kong recently published their findings in the medical journal Spine. They found a novel imaging biomarker that seems to correlate to degenerative disc disease and lower back pain. While the researchers noted that much more investigation is necessary before this imaging protocol is used for diagnosing this painful condition, it has the potential of allowing spine surgeons to gain more insights without being forced to use more invasive testing. As a spine surgeon at Texas Back Institute (https://texasback.com/about-us/), Dr. Jessica Shellock (https://texasback.com/find-a-physician/name/jessica-shellock/) has diagnosed and treated hundreds of cases of degenerative disc disease and her insights about the condition sheds some light on the potential benefits of this research. What is Degenerative Disc Disease? Between each bony vertebral body is a disc (https://texasback.com/conditions/herniated-disc/) that acts as a shock absorber and a hinge. With aging, the disc becomes dehydrated, making it less supportive and more prone to injury. Even a healthy, well-hydrated disc can be injured. The disc is composed of the annulus, which is a tough tissue that makes up the outside of the disc and the nucleus pulposus, which is the jelly-like substance in the center of the disc. What causes these discs to degenerate? "Degenerative changes within a disc are physiologic," Dr. Shellock said. "This means that as our discs age, certain processes occur, including pathologic changes... Read the full article at www.texasback.com/blog

Dr. Kevin Ju, Orthopedic Spine Surgeon at Texas Back Institute talks about the difference in symptoms and treatment options for patients who suffer from Acute Back Pain and Chronic Back Pain. For more information visit: https://texasback.com/treatments/ Join us on Facebook at: www.facebook.com/texasbackinstitute Or Follow us on Twitter and Instagram @TexasBack

For more info visit: https://texasback.com/treatments/surgical-treatments/decompression/ Dr. Kevin Ju, explains what decompression surgery is and who would be a good candidate. So, what is Decompression Surgery? Any surgery that relieves compression of the spinal cord or spinal nerves is considered to be decompression surgery. If the compression results from a disc herniation, the surgery is a discectomy. If the compression is because of a narrowed spinal canal that is placing pressure on the spinal cord or nerve roots, this surgery is a laminectomy. A laminectomy removes the back wall of the spinal canal to create more space for the spinal cord. Visit us at www.texasback.com Join us at Facebook.com/texasbackinstitute

Facet Joint PainAs a former collegiate golfer and current avid player, Dr. Michael Duffy, a spine surgeon at Texas Back Institute, is an excellent source for information on playing the game at a high level without succumbing to back injuries. As a student of the game and its players, he has excellent insights about the causes for the injuries to these two players and how amateur golfers can avoid them. “A lot of what’s going on today is due to the fact that golfers are better athletes than they were decades ago,” Dr. Duffy said. “They are swinging harder and creating more torque with the new, so-called ‘X-factor’ swing, and while this makes the ball travel farther, it can also cause serious injuries to the spine and back. See the full article here: https://texasback.com/is-there-life-after-back-injuries-for-these-two-young-golfers/

Surgeons, such as Dr. Michael Hisey (https://texasback.com/find-a-physician/name/michael-hisey/) of Texas Back Institute, must perform at a high level every time they step into the operating room. In many cases any error – no matter how small – can be catastrophic for the patient. Plus, surgeries can take hours to complete, and it is absolutely critical that the surgeon’s intense concentration remain high throughout the procedure. As someone who is recognized internationally as one of the best in his profession, Dr. Hisey was asked if it is possible for a surgeon to get into a high-performance zone when he is operating on a patient’s spine. “I absolutely believe it is possible for a surgeon to get into this state,” he said. “In fact, it happens to me regularly. If a surgery is getting stressful and there are many things happening at once, I will notice that things seem to slow down, distractions in the room seem to go away, I am able to really focus on what I’m doing and the surgical instruments seem to move very intuitively. “It’s not always easy to start an operation in this state. You have to ‘get there’ through the procedure. In some cases, I will get into a surgery and think ‘wow, this is going to be a tough one.’ There may be lots of noise going on in the room, I’m hearing all of that and having a difficult time getting started. However, once I get started, I will tune out everything but the procedure. Everything fades into the background. It’s not that I’m unaware of everything going on. For example if the anesthesiologist says something to me, I process this information but I am not distracted by it. I simply have tunnel vision where I’m able to focus on what I’m doing.” Read the Full article at www.texasback.com/blog

On any given day, the waiting room of Texas Back Institute is filled with people who are experiencing back pain. In most cases, these patients are over 50 and have age-related causes for their pain, ranging from arthritis, wear and tear from work or other conditions that affect their spine. By and large, back pain is an older person’s problem. However, a form of chronic back pain that affects younger patients has received more discussion and research among spine specialists. This disease is ankylosing spondylitis. According to a report in Medical News, “Ankylosing spondylitis (AS) is a painful and progressive form of spinal arthritis and symptoms of inflammatory back pain often first present in people before age 35. It typically begins in the late teens and early twenties and in severe cases may result in fusing spinal vertebrae and may cause structural damage to hips and other joints. Often misdiagnosed as "just back pain" or undifferentiated arthritis, AS is a systemic inflammatory disease that, in addition to its effect on the spine, can affect internal organs, peripheral joints, and vision.” The Spondylitis Association of America estimates that between 350,000 and one million people in the U.S. suffer from ankylosing spondylitis. However, millions more may have the disease and are unaware of this... Read more at: https://texasback.com/young-adults-take-notice-that-back-pain-may-be-ankylosing-spondylitis-and-it-is-serious/

Epilepsy And New Technologies To Treat The Brain with Dr. Akwasi Boah by Texas Back Institute

Dr. Akwasi Boah, Neurosurgeon at Texas Back Institute explains conservative care treatments for back pain. 90 percent of people who suffer from back pain can be treated using conservative care treatments without having surgery. Some of these conservative care treatments include: ice, heat, anti-inflammatories medication, physical therapy, injections, rhizotomy, and chiropractic care. For more information visit: https://texasback.com/patients/patient-education Join us: Facebook.com/texasbackinstitute

Suffering from back pain can be difficult, and knowing when to seek the help of a specialist can be confusing. Dr. Rey Bosita, Spine Surgeon at Texas Back Institute gives helpful tips on when to see a spine specialist and what red flags to watch for. For more info visit https://texasback.com/patients/patien... Join us at www.facebook.com/texasbackinstitute

Dr. Rey Bosita, Orthopedic Spine Surgeon at Texas Back Institute talks about some myths and facts about back pain. Learn more at https://texasback.com/patients/patient-education/ Join Us at www.facebook.com/texasbackinstitute

Dr. Rey Bosita, Orthopedic Spine Surgeon at Texas Back Institute presents some healthy habits for your back. Use some of these tips in your everyday life to help maintain a healthy spine. Learn more at https://texasback.com/patients/patient-education/ Join us at www.facebook.com/texasbackinstitute

Since its founding in 1977, Texas Back Institute (https://texasback.com/about-us/) has been recognized around the world as a state-of-the-art clinic for spine and neurological treatments. Along with recruiting the best and the brightest spine surgeons and clinicians, the practice has been an important contributor in the development of medical innovations such as artificial disc replacement, treatment for scoliosis, disc fusion and for the testing of many other medical devices on behalf of the Federal Drug Administration. The practice is now earning accolades for its spinal research with the launch of the Spine Biomechanics Laboratory at Texas Back Institute. According to a recent article in the online medical site “Spine Universe,” this team and facility, located in Plano, Texas is “helping patients understand exactly how spine conditions affect their movements and muscle activities, and quantifies how much improvement they have made following spine surgery and other treatments.” One of the leaders of this research effort is Dr. Scott Kutz (https://texasback.com/find-a-physician/name/scott-kutz/), a neurosurgeon at Texas Back Institute. He explained why this research is important to both TBI patients and spine specialists around the world. “From a research perspective, this process is extremely valuable because it allows us, as physicians, to understand what we are accomplishing with surgery. The subjective reporting from patients is not as conclusive. While it is certainly wonderful to have a patient return for follow-up and report that they are feeling better, we need objective measures to prove that what has been done is improving the patient’s health. This research is also important for our practice here at the Texas Back Institute and when it is documented in publications, we can share these results – both good and bad – with other spine specialists around the world.” View full article at www.texasback.com/blog

The Power Swing: Why it’s Causing Severe Back Injuries and Ending the Careers of Young Golfers The world’s top-ranked professional golfer is Jason Day. He is just 29 years old, 12 years younger than his mentor Tiger Woods, and may be nearing the end of his career due to a golf swing that is taking its physical toll on his back. Woods’ history of back injuries has been extensively chronicled, and due to these health problems, he appears to be at the end of his impressive professional career. The Professional Golf Association (PGA) tour has become a young man’s game, with five of the first six tour events in 2017 won by players between the ages of 22 and 24. However, these “young guns,” such as Day, Rory McIlroy and Justin Rose, have all had recurring back injuries force them out of tournaments this year. What in the Name of Lee Trevino is Going on Here? In the words of that great Duke Ellington song from the 1940’s, “It don’t mean a thing if it ain’t got that swing!” These ailing young golfers have several things in common, including their athleticism, but it is their swing that is making and breaking their careers. According to Golf Channel analyst Brandel Chamblee, who has written a popular book on the sport titled “The Anatomy of Greatness,”every swing is different, but Woods, Day and McIlroy embody a stylistic change that has pervaded the sport. In a recent article, he shared his knowledge of the swing traits of some of the greatest golfers in history and found a few key differences in the contemporary swing from past generations. “In general, the modern swing is shorter with more restrictive lower body movement. That requires a more violent turn to initiate the downswing, which takes more of a physical toll than swings from previous golfing greats, such as Jack Nicklaus and Arnold Palmer, that were longer and more rhythmic.” A Competitive Golfer Who is Also a Spine Surgeon... see the full story here: https://texasback.com/the-power-swing-why-its-causing-severe-back-injuries-and-ending-the-careers-of-young-golfers/

An Update on the Ethiopian Twins: Their Miraculous Medical Transformation Continues The lives of two twin brothers from Ethiopia were changed forever in December 2016. Tamirat and Markos Bogale both suffered from a debilitating spine disease called scoliosis. With the help of many organizations in Africa and America, they were transported to Plano, Texas and put in the hands of Texas Back Institute spine surgeon Dr. Ted Belanger, who specializes in procedures which correct this disease. Dr. Belanger shared the good news about these two, brave young men with an update on their post-operative conditions. “Both patients are doing very well,” he noted in a recent interview. “Markos had a more simple surgery than his brother and he is recovering nicely. He should be able to travel back to Ethiopia in late February. Tamirat had a more complicated scoliosis condition, with a greater spinal curvature. His first surgery was successful but he will require another procedure. In the interim between the two surgeries, we will gradually correct his spinal curvature by using a new technology called ‘magnetic growing rods.’” See the full post here: https://texasback.com/an-update-on-the-ethiopian-twins-their-miraculous-medical-transformation-continues/

The ancient Chinese and Indian healthcare providers who were masters of acupuncture, yoga and tai chai must surely be smiling in their afterlife. In a report released during the second week of February 2017, the American College of Physicians released new guidelines for dealing with the most common maladies affecting modern mankind – lower back pain – with these ancient health techniques before prescription drugs and surgery are employed. Many medical experts called these guidelines “historical” in their implication for treating back pain. According to nationwide media reports, such as this one from the Wall Street Journal, the primary reason for the issuance of these new guidelines lies in the epidemic of opioid addiction. “Opioids, one of the most commonly prescribed medications for pain relief and the source of the increasing addiction and death, should only be considered for chronic back pain when other alternatives – natural and prescription – don’t work”, say the guidelines, which were published in the Annals of Internal Medicine. Even over-the-counter medicines such as acetaminophen, which is the primary ingredient in the popular pain medicine Tylenol, is no longer recommended for acute back pain. These new guidelines will most likely influence how doctors such as those at Texas Back Institute treat patients with back pain. However, one of these highly-respected and world-class spinal surgeons, Dr. Michael Hisey, feels most back surgeons and spine experts have been following these guidelines for many years. These Guidelines Have Been Evolving for Several Years... Read the full post here: http://texasback.com/about-us/blog/how-the-new-guidelines-for-treating-lower-back-pain-will-affect-you/

For more info visit www.texasback.com/blog Low Radiation and 3-D Images: Two Reasons Your Next X-Ray Should be Taken with the IOS Machine (Stock photo of an x-ray of the spine) When Professor Wilhelm Conrad Roentgen (http://www.nobelprize.org/nobel_prizes/physics/laureates/1901/rontgen-bio.html) discovered the x-ray while working with a cathode –ray tube in his laboratory in 1895, medical journals of the day immediately understood the significance of this discovery. This ray could pass through most substances, casting shadows of solid objects. What most excited the physicians and dentists about Roentgen’s discovery was that the ray could pass through the tissue of humans, but not bones and metal objects. According to an article (https://www.nde-ed.org/EducationResources/CommunityCollege/Radiography/Introduction/history.htm) on the history of radiography, “Public fancy was caught by this invisible ray with the ability to pass through solid matter, and, in conjunction with a photographic plate, provide a picture of bones and interior body parts. “Scientific fancy was captured by the demonstration of a wavelength shorter than light. This generated new possibilities in physics, and for investigating the structure of matter. Much enthusiasm was generated about potential applications of rays as an aid in medicine and surgery. Within a month after the announcement of the discovery, several medical radiographs had been made in Europe and the United States, which were used by surgeons to guide them in their work. In June 1896, only 6 months after Roentgen announced his discovery, X-rays were being used by battlefield physicians to locate bullets in wounded soldiers.” Unfortunately, with most advances in medicine, there are unintended consequences which are discovered later. Such is the case with effect x-rays can have on the body. For more info visit www.texasback.com/blog

As is the case with many successful people, Dr. Kevin Ju (http://texasback.com/doctors-profiles/doctor-kevin-ju/) was an over-achiever as a child and young adult. When he was growing up in Houston, his parents – a computer programmer mom and a chemical engineer dad – encouraged his curiosity about how things worked. “I spent a lot of time taking things such as microwave ovens and lamps apart and then putting them back together,” he said in a recent interview. “In spite of having no doctors in my family, I was interested in biology and the human body at a very early age. I was fortunate to do some research at Baylor Hospital when I was in high school and was allowed to shadow a surgeon early on. This got me interested in medicine.” Next stop for Dr. Ju was the prestigious Stanford University in Palo Alto, California. He majored in biology and wrote an honors thesis in neurobiology (http://neurobiology.stanford.edu/) as an undergraduate. He decided to attend medical school and was accepted to one of the best in the country. “I went to medical school at Harvard and then stayed in Boston for my residency training,” he said. His time in Boston was marked by a tragic event that forever changed the way this young, brilliant surgeon would perceive the world around him. No amount of academic success, parental support and training could have prepared him for what was to happen on the darkest day the city of Boston has ever witnessed. Read the full blog at www.texasback.com/blog

“We’re all wired to sleep differently,” Dr. Bosita said in a recent interview. “Some of us are natural side-sleepers, some sleep on our backs and others sleep on our stomach and those natural sleeping positions can sometimes make back pain worse. “Many times, a person will feel uncomfortable when trying a new sleeping position because it doesn’t feel right. One of our goals at Texas Back Institute is to help our patients get their back pain under control so they can sleep in the most comfortable position for them.” “A person with spinal stenosis, for example, typically experiences pain when they extend their spine,” he noted. “If a person is a natural back-sleeper, the firmness of the mattress will have the effect of extending the spine a small amount, making the back and leg pain worse. “In some instances, people will roll over quickly and they will suddenly wake up because their back pain will get acutely worse. For someone who is sleeping fitfully, the mattress may be the cause and sudden movements can increase the back pain. “Regardless of the sleeping position, it’s my job to help our patients manage their pain so that they can sleep in any position.” View the full story at www.texasback.com/blog

It’s rare when a world-class spine surgeon and internationally respected scoliosis expert is also an enthusiastic yoga practitioner. However, such is the case with Texas Back Institute’s Dr. Isador Lieberman (http://texasback.com/doctors-profiles/doctor-lieberman ). This high-energy physician is putting all of these skills in play during a special event on Saturday, June 25, 2016. For the second year, Dr. Lieberman, Texas Health Plano Scoliosis and Spine Tumor Center and Texas Back Institute ( http://texasback.com/about-us/ ) are combining forces for “Stretch for Scoliosis,” a two-hour, fun-filled event to promote the National Scoliosis Awareness Month. Held at the Plano Sports Authority, which is located at 6500 Preston Meadow Drive and running from 9:30 a.m. until 11:30 a.m., this special workshop will teach parents and children about how core strength and flexibility can be improved. Screening for Scoliosis This event will also allow scoliosis specialists to screen adults and children for this very serious, however controllable spinal problem. Dr. Lieberman explains. “For those who might not be aware it, scoliosis is a curvature of the spine where people are either bent forward or sideways,” he noted. “This, of course, leads to discomfort and limited mobility.” “Over the years, we’ve been big advocates in trying to improve posture. As a surgeon, I can improve the posture of someone suffering from scoliosis, but there are many people who have unbalanced posture, with a spinal deformity – whether this situation is caused by scoliosis or other factors – who could benefit from an active program of posture exercises. This will help them regain their balance and improve their function.” “Yoga, Pilates as well as general stretching all help with this condition and we designed this Stretch for Scoliosis program with this in mind,” he said. “This is our second year and we are trying to raise the awareness of how to keep one’s back healthy and maintain good posture using an active exercise program which includes yoga and Pilates type exercises that will allow someone with a spinal deformity to have a better quality of life.” Read the full blog post here: www.texasback.com/blog

Dr. Bosita Talks About Pros And Cons Of Crossfit by Texas Back Institute

Eric Clapton, one of the world’s best-known blues and rock guitarists, has been playing his instrument professionally since 1962 and now, at age 71, he is being forced to seriously consider retirement. This has nothing to do with his popularity. In fact, he released a new album of songs entitled “I Still Do” in May 2016, to rave reviews. According to a recent article in the Washington Post, Clapton is experiencing nerve damage which is making it extremely painful to play guitar. He was quoted in the article. “I’ve had quite a lot of pain over the last year,” Clapton told “Classic Rock” Magazine. “It started with lower back pain and turned into what they call peripheral neuropathy, which is where you feel like you have electric shocks going down your leg. And I’ve had to figure out how to deal with some other things from getting old.” As the most recent addition to the Texas Back Institute team of spine experts, Dr. Scott Kutz, specializes in neurosurgery and, in addition to being an Eric Clapton fan, has several insights about this painful condition. “Peripheral neuropathy is a disorder affecting the peripheral nerves of the body, which is a part of the central nervous system,” he said. “This can affect one nerve, in which case it is known as a mono-neuropathy, or it can affect multiple nerves where it is known as a poly-neuropathy. “This condition is fairly common and there are several different types and multiple causes of neuropathy. In the case of a mono-neuropathy, the most common type is carpal tunnel syndrome , where the medial nerve is compressed in the area of the wrist and causes pain, tingling, numbness, swelling and it can affect one’s strength. For the Full story visit www.texasback.com/blog

Why Do Pregnant Women Experience Back Pain? The Two Reasons Might Surprise You. There is not a more joyous time in the lives of a couple than when they are expecting a child. Words are inadequate to describe this experience. This process of bringing a new life into the world is simultaneously invigorating and more than a little scary! During pregnancy, a woman’s body undergoes many changes in order to accommodate the birth, and this often results in the expectant mom experiencing back pain. In most cases, this pain is common. However, to paraphrase a wise person: “Pain is not common if it is YOUR pain.” To explain why back pain often occurs in pregnant women, Dr. Jessica Shellock, a back specialist at Texas Back Institute was asked for her professional opinion. In the process giving this explanation, she also offered some suggestions on dealing with this pain. The Causes of Back Pain “There are two primary causes for back pain in women who are pregnant,” noted Dr. Shellock. “As the baby is growing in the uterus, its weight increases, which causes a strain on the lower back of the expectant mother. In order to accommodate this weight, a woman will change her posture – hyper-extending her lower back in order to maintain balance. This causes muscle strain and leads to pain. “The other reason for this pain is due to the hormonal changes that occur during pregnancy,” she said. “Estrogen is a relaxant and it fluctuates in a woman’s body during this period of pregnancy. These hormones are preparing her body for childbirth. They loosen some of the ligaments, which allow the baby to pass through the birth canal. Both of these factors can cause increased fatigue and back pain.” “These changes in a woman’s body during pregnancy don’t typically cause long - term injuries,” Shellock said. “However, women who are prone to having back pain are going to be more likely to experience back pain during their pregnancy. “In most cases, after delivery, the pain will subside,” she said. “This is due to the woman losing that ‘baby weight’ and her hormones regrouping to their normal levels.”

The Brain Trust at Texas Back Institute is Growing – Welcome Neurosurgeon Akwasi Boah The newest member of the world class surgical team at Texas Back Institute is a native of Brooklyn, New York and is a first generation Ghanaian American. Dr. Akwasi Boah was introduced to the medical profession as a toddler. “My father was a pediatrician and my mother was a nurse when I was born,” he said. “Later, my mother became an entrepreneur.” He graduated from Saint Joseph’s University in Philadelphia with a degree in Interdisciplinary Health Services with a minor in Biology and was accepted by the Morehouse School of Medicine in Atlanta. Clearly, this medical school was a long way from his home! “I thought Atlanta was on another planet,” Dr. Boah laughed. “But I had one of the most amazing experiences of my life there. From there, I came back home for surgical training at New York University School of Medicine, and did a fellowship at Johns Hopkins in their Department of Neurosurgery. “As it turned out, I had a family member who lived in Dallas and when I came down to visit, I took the opportunity to meet with Texas Back Institute and thought this organization was just fantastic. They have internationally renowned surgeons and among the ‘spine universe,’ TBI is very well known.” Visit www.texasback.com/blog for more information.

Olympians from all over the world are competing in the 2016 Summer Olympics in Rio de Janeiro and American athletes, who come from just about every state, will also be “going for the Gold.” However, with these games, the state of Texas has something (else) to brag about. Every member of the 2016 U.S. Olympic Taekwando team hails from the Lone Star state. More on this team, later. Dr. Rajesh Arakal (http://texasback.com/doctors-profiles/doctor-arakal/), a spine surgeon at Texas Back Institute (http://texasback.com/about-us/), is also an enthusiastic martial arts practitioner. In a recent interview, he explained the difference between taekwando (https://en.wikipedia.org/wiki/Taekwondo) and other martial arts. “When I was in medical school, there was a dojo where a lot of us medical students, residents and doctors would attend,” he said. “We would meet twice a week for three to four hours, training for taekwondo and mixed martial arts. It was my first opportunity to be exposed to taekwondo and I truly appreciate the art form. “Historically, taekwondo originated in Korea,” Dr. Arakal noted. “It incorporated the countryside tools of the native farmers as a protection against invaders from Japan. As for karate, this originally came from Japan. “In many ways, taekwondo is a ‘circular’ sport. It’s a lot about balance. Because Koreans were somewhat smaller than say the Japanese, they required moves that would increase their reach. It became a sport that emphasized kicking – specifically round-kicks – so that the athlete could have a great arch of penetration when fighting an opponent. It negated the shorter stature of the people who were practicing.” See the full article at www.texasback.com/blog

Dr. Isador Lieberman, a spine surgeon at Texas Back Institute and dedicated physical fitness participant has a great deal of experience with all types of rowing machines, including the WaterRower. “I’ve been rowing for more than 20 years,” he said. “And I am well-aware of this particular type of rowing machine,” Besides its prominent “role” on the show, what makes this WaterRower so appealing? “I believe it’s the act of rowing and not the rowing machine itself,” he said. “Rowing is a very high-intensity exercise program, which when done properly, exercises just about every muscle in your body. You can burn off a lot of calories in a very short span of time. Plus, you get a full-body workout with minimal impact. So, you are not overwhelming the joints.” “Rowing as an exercise has tremendous appeal,” he said. “It is much more engaging than running, swimming, riding a stationary bike or road bike.” More Than 10 Million People are Rowing The exposure this machine has received from this show has increased the popularity of the entire category of equipment. It is estimated that more than 10 million people used a rowing machine last year. This does not surprise Dr. Lieberman. “I recommend rowing to a lot of my patients,” he said. “Plus, I have a number of friends who know that I am an avid rower and they ask me if rowing helps me burn off weight and if it helps me to get through the frustrations of the day. After I tell them, they go and buy their own rowing machine, and they become as addicted to it as I have.” Potential Injuries Who better than a spine surgeon would realize the potential for injuries from using a rowing machine? “First and foremost, when you’re rowing, you are pulling on the bar which is attached to the chain and a flywheel, or in the case of the WaterRower, the flywheel in the water. That provides the resistance. There are other rowing machines where the flywheel uses air resistance, whereby the rower is pulling on a big fan.” “Regardless of the type of machine, what is really critical is to maintain the proper form,” he said. “All too often I see people in the gym getting on these machines and then flailing their arms, back and legs. They are going to be prone to a low back injury. It’s important to keep the stability of the pelvis, the abdominal and back muscles are kept tight and you want to be pushing with your legs. You don’t want to be pulling with your lower back. Form is critically important.” “The second important consideration concerns the stirrups on the machine. You need proper shoes and you need to have your feet strapped in to these stirrups or footplates. Your feet need to be secure because as you are pulling back and moving forward, you don’t want your feet moving erratically. This could cause a twisted ankle or injury to the tendons around the feet.” How Long is Too Long on a Rowing Machine? “If you’ve got the stamina, and you’re using proper form, you can stay on the rowing machine until you exhaust your stamina,” Dr. Lieberman noted. “If you have poor form, you will be hurting your back within 30-seconds. It all depends on what kind of condition the participant is in.” “I know people who can be on a rowing machine for 45 minutes to an hour without even breaking a sweat. A lot also depends on how much resistance someone is rowing against and how much force you are putting into it. It’s similar to pedaling a bike. You can coast part of the way, or you can push the pedals for more speed and cover more territory.” For the full blog post visit www.texasback.com/blog

Texas Back Institute is constantly striving to bring new expertise to its practice and the latest evidence of this effort is Dr. Scott Kutz, a neurosurgeon who joined the organization in June. The latest addition to the surgical team at TBI grew up in central Illinois and before landing in the Dallas-Fort Worth area he spent time in Chicago, New Orleans for his medical education and St. Louis and Springfield, Missouri in the early years of his medical practice. In a recent interview, Dr. Kutz said, “I originally wanted to practice relatively close to central Illinois in order to be close to my family. However, the climate for medicine is much more challenging and rewarding in the St. Louis, Springfield and ultimately the DFW areas.” What made Dr. Kutz decide to join the team at Texas Back Institute? He didn’t hesitate in his answer. “Texas Back Institute is a phenomenal facility,” he said. “They have a wonderful combination of doing excellent clinical work combined with cutting edge research and medical education.”

One of the objectives of a recent trip into space was to determine the long-range effect on “the mind, body and spirit” of the travelers into this last frontier. The agency which supervises all government-sponsored trips into space – The National Aeronautics and Space Administration (NASA) recently announced the safe return of astronaut Scott Kelly who had spent the last year living in the Space Station. This is longer than anyone else had previously done. The ramification of this trip – a medical experiment, in fact – is fascinating for the scientists at NASA and the spine specialists at Texas Back Institute. Why? According to news reports, including this one from NBC, Scott Kelley’s body changed while he was living in outer space. In addition to other possible effects of the weightlessness of outer space (yet to be determined), Kelly appears to have grown about 2-inches during this period. This fact is corroborated by a comparison with Scott’s brother, Mark, who is an identical twin and thus has the exact genetic makeup. This medical experiment, with one brother acting as the test subject and the other acting as the “control,” is critical to devising a medical and physical regimen for astronauts who, on future trips to planets in this solar system such as Mars, will be required to live in these conditions for sometimes decades. Before discussing these myriad medical mysteries, the obvious first question is clearly begged. Did the effects of 1-year of weightlessness, the closed quarters or other factors cause Scott Kelly to grow an additional 2-inches? For the answer to this, Texas Back Institute spine surgeon Dr. Rey Bosita was asked for his professional opinion. Read the full post here: www.texasback.com/blog

This is the time of year when the bats are swinging, the baseballs are flying and the boys and girls of summer are at least thinking of the words to the world’s best baseball song… “Put me in coach. I’m ready to play. Today” As the official spine surgeons for the Frisco RoughRiders, a minor league affiliate of The Texas Rangers, the specialists at Texas Back Institute examine many of these young players when back injuries strike. Often, these injuries are exacerbated when young players – middle school, high school, collegiate and professional - try to “play through the pain.” A recent article in the Wall Street Journal noted overuse injuries are a serious problem, particularly for younger boys and girls. These are caused by the repetitive stress of the muscles and skeletal system without giving them enough rest. According to the article, more than 50 percent of the pediatric sports injuries occur due to a focus on a single sport by a young athlete. Teams, of all skill levels, are trying to combat these injuries due to overuse by giving a greater role to athletic trainers. In an effort to determine is this is a positive trend or one that is dangerous, Dr. Rey Bosita, a spine surgeon at Texas Back Institute, was asked to give his professional pitch. See the full story here: www.texasback.com/blog

Why Air Travel Can be Hazardous to Your Health Anyone who spends a lot of time on an airplane has a clear understanding of the concept of misery. Except for those lucky travelers who are in “first class,” the other 200 or so people spend the duration of the flight cramped, with little leg room, closely seated next to other passengers who are often grouchy due to their own lack of space! Dr. Michael Hisey http://texasback.com/doctors-profiles/doctor-hisey is a spine surgeon at Texas Back Institute and his work in the field makes him a highly-sought-after speaker for medical conventions all over the world. Because of this, Dr. Hisey has become somewhat of a “road warrior” and as such, is the ideal source for offering tips on avoiding the back pain which can result from hours and hours on an airplane. He has also had some quirky experiences that can only happen to a doctor on a plane. “Recently, I’ve had some long trips to Uganda and China,” he said. “I’ve also got a trip coming up to Singapore. See more at www.texasback.com/blog

Can plunging one’s entire body into a freezing chamber reduce muscle pain? For the professional athletes and celebrities who have made cryotherapy so popular, the answer is yes. If the media coverage is any indication, extreme cold is very hot. Many athletes, movie stars and other opinion leaders have publically extolled the benefits of Whole Body Cryotherapy https://en.wikipedia.org/wiki/Cryotherapy for losing weight, reducing pain, improving athletic performance, slowing aging and improving sleep. However, this relatively new treatment has not been vetted by any reputable medical organization and has had some tragic consequences for at least one young lady. According to an article in Forbes http://www.forbes.com/sites/brucelee/2015/11/23/the-cold-hard-facts-on-cryotherapy/#1d8c1a691334 magazine, “the recent death of 24-year old Chelsea Patricia Ake-Salvacion during a cryotherapy treatment has brought some increased scrutiny on a practice that has been growing in use worldwide.” To find out just how effective cryotherapy is in reducing back pain, Dr. Nayan Patel http://texasback.com/doctors-profiles/doctor-patel of Texas Back Institute was asked for his opinion on the extreme version of ice packs on a hurting back. Read the full story here: www.texasback.com/blog

Beginning on April 28th and running through April 30, 2016, the owners of the teams of the National Football League (NFL) will decide which eligible players they think will help take them to a championship. The NFL Draft has become one of the most-anticipated events of the sport’s off-season with fans quoting arcane statistics like a player’s bench-press best, his “vertical leap” or his 40-yard dash times in justifying the choice of one player over another. However, these physical and psychological tests and measurements seldom tell the whole story about these young men. The discipline necessary succeed in this highly competitive situation is one of those factors which even the most experienced coaches find hard to quantify. Plus, existing and potential physical weaknesses, which can lead to future injuries, make it difficult to determine which players are likely to make it through the entire, grueling NFL season. Since back injuries have become a major cause of players missing time on the field, Dr. Shawn Henry, a big pro football fan and spine surgeon at Texas Back Institute, was asked for his ruling on the field of NFL prospects. Read the full story at www.texasback.com/blog

It has been noted by more than a few armchair philosophers that “it’s the little things that add up to big problems.” This aphorism applies to many things including back pain. Whether it is poor posture, improper lifting techniques or any number of other bad habits, when they are continued for years, these little things can add up to big pain. Back pain can be the unintended consequence of everyday activities. In some extreme cases, long term damage to the muscles of the back and even the spine can occur. Correcting or avoiding these activities might save a trip to Texas Back Institute. Common Causes for Back Pain “There are certainly many culprits around the house,” noted Dr. Stephen Tolhurst, a spine surgeon at Texas Back Institute. “The most common problems involve lifting improperly. Failing to bend at the knees to lift a heavy object and putting extreme stress on back muscles can wreak havoc on the back.” “Another common cause for back pain involves staying in one position for a long time with your lower back bent forward. People can also notice significant neck pain when looking upward, keeping one's neck in that position for an extended period of time." Why would someone spend an extended period of time, looking up? “Simply sitting on the floor, looking up at a television for several hours,” Dr. Tolhurst noted. “Or, if someone is changing light bulbs or doing maintenance work around the house such as cleaning ceiling fans. This task can only be completed by looking up for an extended period of time.” Read the full story here: http://texasback.com/about-us/blog/common-activities-which-are-causing-your-back-pain/

Text Neck is More than a Cute Term. It’s Seriously Painful People, of all ages, staring down at a small screen for hours every day could have a real problem. As was noted in a previous blog post (http://texasback.com/about-us/blog/text-neck-its-nothing-to-lol-about/), this has resulted in the rise of a non-medical, but extremely descriptive term: Text Neck. It has also resulted in patients showing up in the Texas Back Institute waiting room, complaining of sore necks. More on this later. Dr. Rey Bosita, a spine surgeon at Texas Back Institute notes, “This is a pain in the back of a person’s neck, caused by poor back posture while looking down at smartphones, tablets or other electronic devices.” “The cause of text neck is the same for both kids and adults,” he said. “People have a tendency to hold a mobile device down in the lap or down on a low surface, while keeping the neck flexed. When that happens, the muscles in the back of the neck get fatigued. When users finally get distracted from dealing with “Angry Birds,” email, or FaceBook, they feel pain when they try to lift their heads.” “The problem with text neck is that people might keep their heads in this position for several minutes or several hours every day,” he noted. “This causes a cumulative pain effect. Text neck affects both kids and adults. The biomechanics are the same, whether a person is young or old. The most important thing is to try and prevent it.” The constant use of hand-held technology is causing other unintended consequences besides text neck. According to research published in the Journal of the American Medical Association, “electronic toys hinder verbal development and traditional toys, such as common building blocks, sparked higher quality conversations among children.” Dr. Bosita, while not a child psychologist, is the proud dad of 4 youngsters, and he has first-hand experience with the benefits and challenges of smartphones, tablets and other electronic gadgets in the hands of kids. Does he see any backlash brewing with regard to allowing kids unlimited use of hand-held devices? “I agree with the statement that electronic games can hinder verbal development,” he said. “Parents have to be cognizant of this problem, especially with the little kids. Make sure the kids play with the traditional toys and have enough personal interaction with each other to make sure this ‘locked in’ situation doesn’t happen where the kid’s iPad becomes his or her world.” Read the Full Blog at www.TexasBack.com/blog

In the history of medicine, there are very few diagnostic procedures which have had the impact of magnetic resonance imaging, more commonly known as MRI. The MRI scanners use magnetic fields, radio waves and field gradients to form images of the anatomy and they are capable of revealing the physiological properties of the body, including disease and injuries. The MRI process was patented and introduced to physicians in the mid 1970’s, and one of the early adopters of this technology was Texas Back Institute. Recently, one of the three founders of Texas Back Institute, Dr. Richard Guyer, shared his insights about the value of the MRI scans for spine diagnosis. A New MRI Technology Texas Back Institute has a rich history of pioneering new medical technology and the organization has one of the first MRI’s designed for spine diagnostics. Dr. Guyer explains how this new machine differs from the traditional MRI. “First of all, it’s a more compact MRI scan,” he noted. “Plus, it is much cheaper than the traditional MRI scan and it works off a lower magnetic field.” “Just as we see advancements in other fields, such as electronics, cell phones or computers, the developers of this new MRI, with very low magnetic fields, are able to get good images.” “The other advantage of having a low magnetic field is that it allows patients who have had previous surgeries and have various metal implants – such as screws, rods and cages – to hold the spine together will cause what we call ‘scatter.’ That means we are unable to get good pictures with a regular MRI scan. With this low magnetic field scan, they have developed special software that allows us to see better images of the nerves and the bones despite the hardware in these patients. (Image of the new MRI, without patient) “This new MRI has another important advancement,” Dr. Guyer noted. “It has the ability to take upright images. The reason why this is important is that in many spinal abnormalities, patients don’t hurt when they’re lying down. They say, ‘doctor, I hurt when I’m up on my feet or when I stand too long or when I’m walking.’ Now, we have the ability to take an MRI scan when the patient is in a standing position. “This is what we call being in a ‘loaded’ position, where the weight of the body is being transmitted through the spine and through the disc and may actually cause a bulging of the disc. This can cause a pinching of the nerves and may also cause instability. These conditions are not going to be visible when the patient is lying flat on their back.” “I’ve had numerous patients who have normal MRI scans while they were lying on their backs,” he said. “And when you stand them up for regular, plain x-rays, we see that they have abnormal motion. Read the full text at www.texasback.com/blog

Dr. Ralph Rashbaum, co-founder and Orthopedic Spine Surgeon at Texas Back Institute talks about SI Joint disfunction, the symptoms, and treatment options for it. Si Joint disfunction is often misdiagnosed, and goes untreated for many patients. For more information visit: www.texasback.com

Dr. Stephen Hochschuler, Co-Founder and Orthopedic Spine Surgeon at Texas Back Institute talks about the history and philosophy of the multi-disciplinary spine practice. Texas Back Institute has been caring for patients with neck pain and back pain for over 35 year, and built a strong reputation in the spine care community. Texas Back Institute is dedicated to research in new technologies and procedures. Dr. Hochschuler discusses some of these technologies and fun stories from the early years. For more information about Texas Back Institute visit: www.texasback.com