MoMentuMMoMentuMThe Campbell FoundaTion

Enhancing Quality of Life Through the Science of Orthopaedic Medicine • Fall 2009

Beverly littlejohn endured an aching Back and leg pain for years Because she feared open surgery. new developments that lessen recovery times and post-operative pain helped change her mind.

A reluctant patient is now pain free, thanks to minimally-invasive surgery

Beverly Littlejohn could write a book about chronic back and leg pain. She has seven years worth of stories to fill the pages, along with a happy ending to share with others suffering with similar symptoms.

Like many people with serious back problems, Beverly pursued multiple options as she sought relief for her chronic condition. She visited several doctors, took oral medications, had nerve blocks and steroid injections, tried physical therapy, saw a chiropractor, and made numerous accommodations to her lifestyle during the years she was attempting to lessen the tormenting ache in her back.

“I tried everything I heard about and could think of except one thing — and that was surgery,” Beverly said.

“The pain was bad, but not as great as my fear of major surgery on my back.”

Two things changed Beverly’s mind. As her pain worsened, she grew troubled by the number of injections and pills she was taking to deal with the discomfort. And, Beverly learned more about minimally-invasive back surgery from Dr. Raymond Gardocki of Campbell Clinic, her doctor for the past several years.

“In the short time since I started considering back surgery, they’ve made amazing progress in surgical techniques and treatments,” Beverly said. “I was afraid of the kind of surgery where you have a really large incision and a long recovery time. Minimally-invasive surgery helped me overcome most of my fear.”

A common problem for Boomers

One-half of all working Americans admit to having back pain symptoms each year. Back pain affects 80 percent of Americans at some time in their lives. It is the second most common reason for visits to the doctor’s office, outnumbered only by respiratory infections.

Back problems are particularly common among Baby

Boomers, that part of the U.S. population born between 1946 and 1964. More “weekend warriors” who swing between little exercise and too much; increasing obesity; and a busier, more active lifestyle make the Boomer generation vulnerable to back problems.

Beverly Littlejohn is 57, a Baby Boomer with a number of risk factors for back pain. She’s the mother of four children, and a woman’s back is significantly stressed by carrying a baby. She’s gained some weight through the years. With a fulltime job and a household to run, she doesn’t get enough exercise.

While the chances for back problems are apparent for those working in certain occupations that require heavy lifting or standing all day — construction workers, warehouse handlers, and retail clerks, for example — Beverly’s work is a less obvious risk factor. She is a contact representative for the Internal Revenue Service, which means she sits for eight hours at a desk while talking on the telephone.

“I’ve never had a really strenuous job, and I’ve never had an injury that directly affected my back,” said Beverly.

“Age and the wear from staying busy all the time just caught up with me.” continued on page 2

Minimally-invasive

surgery helped IRS

employee and grand-

mother Beverly Littlejohn

resume her busy lifestyle.

Searching for relief

Beverly’s backaches began in 2002. At work, her back and legs would hurt when she stood up after a morning of sitting, so she began staying at her desk all day. When she went shopping, her husband Kenny started dropping her off near a store’s front door, then finding her a motorized cart to ride in while shopping. She was helping care for a grandson after school, and her back would ache from picking up toys and doing housework.

“I suffered in silence for awhile, then went to an orthopaedic doctor in 2004,” she said. “When he said I needed surgery, I decided against it. I talked to people who had had back surgery, and some said it made their problems worse, not better. Then I saw a video on TV of a six-hour, open back surgery, and the fear factor set in. I was certain that I didn’t want to be sedated for six hours, or take months to recuperate.”

Beverly’s doctor prescribed a painkiller. It worked but made Beverly so drowsy she couldn’t do her job. She developed a tolerance for pain medications but worried about taking so many pills.

In 2005, Beverly began seeing Dr. Gardocki at Campbell Clinic. An MRI revealed Beverly had degener- ative spondylolisthesis, a medical term for one vertebrae sliding forward out of alignment with an adjacent vertebrae. It is commonly called a slipped disc and can cause back and leg pain by compressing the lumbar nerve roots.

“Injections, medications, and physical therapy are con- servative ways of treating a degenerative spondylolisthesis, but it usually responds best to surgery,” Dr. Gardocki said.

“Ms. Littlejohn elected to try epidural injections, which brought her some relief initially.”

Beverly drives her grandson, Jordan, to classes at St. Dominic School several

days each week.

By 2008, Beverly had begun to hear and read about minimally-invasive back surgery, which can be done on an outpatient basis. “Dr. Gardocki explained the surgery in detail, and it really helped me to relax,” she said.

“Minimally-invasive surgery is much more appealing to the patient and the surgeon,” Dr. Gardocki said. “Minimally-invasive techniques preserve normal functioning tissue and cause less collateral damage. That allows the surgeon to perform the procedure faster through smaller incisions with less blood loss, less post-operative pain, and less damage to normal tissue. This all results in a quicker recovery.”

Life without limits

In October 2008, Beverly Littlejohn underwent an L4-L5 minimally-invasive transforminal interbody fusion procedure at Campbell Clinic’s surgery center. Dr. Gardocki opened up the spinal canal, removed the degenerated disc, and fused the L4 and L5 vertebral bodies together using bone morphogenic protein and a plastic spacer. Four pedicle screws and two rods were inserted to hold the bones in place.

“I stayed overnight at the surgery center, then went home,”

One-half of all working Americans admit to having back pain symptoms each year.

Experts estimate that as many as 80 percent of the population will experience a back problem at some time in their lifetime.

Back pain is the second most common reason for visits to the doctor’s office, outnumbered only by respiratory infections. Americans spend at least $50 billion each year on back pain, and back problems are estimated to cost the economy over $60 billion a year in lost productivity.

SOURCES: AAOS. Web MD. The Arthritis Foundation.

Back pain facts

Dr. Raymond Gardocki

“Minimally-invasive techniques preserve normal functioning tissue and cause less collateral damage. That allows the surgeon to perform the procedure faster through smaller incisions with less blood loss, less post-operative pain, and less damage to normal

tissue. This all results in a quicker recovery.”

— Dr. Raymond Gardocki

Campbell surgeons, residents contribute to quest for better orthopaedic treatments

Minimally-invasive surgery (MIS) is one of a number of remarkable advancements in orthopaedic medicine in recent decades that mean enhanced options for patients. Campbell surgeons and residents are playing a role in these advancements through clinical research.

Most traditional back surgeries require a long incision that usually has to be made through muscle, which needs a significant time to heal after surgery. Because there are no long incisions in MIS, there is less tissue damage and smaller, less noticeable scars.

Studies have shown that patients undergoing MIS procedures report less pain. Patients who undergo MIS procedures are usually able to go home sooner and, in many cases, the patient is able to return to normal activities and work more quickly.

Beverly Littlejohn’s surgeon, Dr. Raymond Gardocki, is among the Campbell doctors and residents who are collecting data on MIS procedures performed at Campbell Clinic to share with the medical community through research papers and presentations.

“Clinical trials are the best way for doctors to learn what is safe and effective in new devices, procedures, and treatments,” said Dr. Terry Canale, President of The Campbell Foundation and chairman of the Foundation’s Research Committee. “Thousands of people are helped each year as a result of clinical trails, and we participate to help our patients and to improve the practice of medicine.”

“I don't have to limit myself because of back pain anymore.” — Beverly Littlejohn

Beverly said. “I could tell immediately that my back was better. I had to be careful about bending over for a couple of months, but I was up and around within a week. I’ve always been somebody who bounces right back.”

“Ms. Littlejohn has progressed to a rapid, full recovery,” said Dr. Gardocki. “She has no activity restrictions, and her prognosis is excellent. The spot we operated on should not give her any trouble in the future.”

Two months after surgery, Beverly and Kenny spent the Christmas holidays with their son’s family in Washington, D.C. Beverly helped cook the holiday dinner, then sat through a long movie in comfort. In February 2009 she returned to work, where management had installed a special chair to help with her back. She has since joined a spa, where she plans to exercise and do water aerobics.

“There aren’t enough hours in the day to do all I want to do,” Beverly said, “and now I feel like doing everything again, since my surgery. There’s a new job posting at work that interests me. I need to get my house organized, and I want to spend more time with my grandchildren.”

Since her successful surgery, Beverly has also begun thinking again about one of her long-held dreams: to return to nursing school.

“I already have some hours, and I want to finish what I started,” she said. “Our church goes on medical mission trips to Africa, and I want to participate. Caring for others is my passion. Now that I’m in good health again, I believe I can do it. I don’t have to limit myself because of back pain anymore.”

Tips for preventing back problems

Maintain a healthy diet and weight. Lift with your knees, keep the object close to your body,

and do not twist when lifting. Remain active. Avoid prolonged inactivity or bed rest. Maintain proper posture. Make sure that your desk chair and/or computer workstation

are ergonomically correct. Wear comfortable shoes, and sleep on a mattress of medium

firmness to minimize any curve in the spine. Quit smoking. Smoking impairs blood flow, resulting in

oxygen and nutrient deprivation to spinal tissues.

SOURCES: AAOS. The Cleveland Clinic.

Before her surgery,

Beverly rode a

motorized cart while

shopping. Today, she

can “shop til she drops”

without back pain.

YOU CAN HELp Become our partner in

improving treatment and care through research.

The Campbell Foundation supports research by Campbell surgeons and residents that is

making a difference in the lives of people around the world.

Your contribution will help us do more. Call (901) 759-5490. Or visit

the Foundation’s Web site at www.campbell-foundation.org

r e s e a r c h n e w s

Campbell residents join clinic staffIn August, the Campbell Clinic welcomed new physicians specializing in orthopaedic oncology, trauma, and shoulder and elbow surgery.

Dr. Matthew Rudloff has joined the Campbell staff as a trauma specialist. Dr. Rudloff received his medical degree from the Medical College of Ohio and completed his orthopaedic residency at University of Tennessee-Campbell Clinic. He recently completed a trauma fellowship at Denver- Health in Colorado.

Dr. Patrick Toy received his medical degree from University of Tennessee-Memphis and completed his orthopaedic resi-dency at University of Tennessee-Campbell Clinic. He joins the staff as an orthopaedic oncology specialist, after serving an Oncology Fellowship at University of Florida in Gainesville, Florida.

Also joining Campbell Clinic is a specialist in shoulder and elbow surgery. Dr. Quin Throckmorton received his medical degree from the University of Iowa College of Medicine and completed his orthopaedic residency at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Throckmorton served a Shoulder and Elbow Surgery Fellowship at Mayo Clinic School of Graduate Medical Education in Rochester, Minnesota.

Education update

Dr. Matthew Rudloff

Dr. Quin Throckmorton

Dr. Patrick Toy

Each time a surgeon performs an operation, he learns something. Clinical research projects and presentation of the research results enables a surgeon to share his findings with his peers, so more patients can benefit from innovative treatments such as minimally-invasive surgery.

At the Society for Minimally Invasive Spine Surgery’s annual meeting in October 2009, Dr. Raymond Gardocki of Campbell Clinic presented four separate e-posters, including one titled “Minimally Invasive Transforaminal Interbody Fusions in an Outpatient Surgery Center: Initial Three-Month Results.”

Dr. Gardocki’s study reported on data collected for 11 transforaminal interbody fusion surgeries using minimally-invasive techniques and performed in Campbell Clinic’s outpatient surgery center between September 2008 and May 2009.

The surgeries were performed using an 18-20 mm fixed tubular retractor (about the size of a dime) that requires little more soft tissue disruption than a standard miscroscopic lumbar discectomy. The surgeries averaged just over two hours with minimal blood loss. This technique, combined with a multimodal pain management approach used in the surgeries, allows for the operation to be performed in an outpatient setting with quick recovery, according to Dr. Gardocki.

Data included in the presentation indicated a 65% improvement in pain scores (from 8 to 2.8 graded 0-10 on a 100mm scale) by the three month post-operative mark, as well as a one third decrease in the number of patients using narcotics after three months.

“Using a minimally-invasive tissue sparing technique and an aggressive pain management approach, minimally invasive transforaminal interbody fusion surgery can be safely performed in an outpatient setting with good initial results,” Dr. Gardocki’s study concluded.

Dr. Gardocki’s research will help other doctors treat spine patients

Minimally invasive fusion scars laterally and traditional discectomy scar in the midline

9

8

7

6

5

4

3

2

1

0

pre-op 2 week 6 week 3 month

Pain level pre and post op

8.0

3.73.0 2.8

70%

60

50

40

30

20

10

0

pre-op 2 week 6 week 3 month

Pain improvement %

0%

54%

65%62%

e d u c a t i o n n e w s

Congratulations Class of 2009

Dr. David Richardson

“The University of Tennessee-Campbell Clinic has been one of the nation’s premier orthopaedic residency programs for many decades. I am dedicated to continuing this tradition of excellence and am grateful for this opportunity.”

— David Richardson, M.D.

Back, from left:Dr. Jason Lake, Foot & Ankle Fellowship, Cleveland, OH Dr. Scott Abraham, private practice, Overland park, KS Dr. Matt Busbee, Sports Medicine Fellowship, Birmingham, AL Dr. Jack Conoley, Sports Medicine Fellowship, Campbell Clinic

Dr. David R. Richardson has been named Director of Education for the University of Tennessee-Campbell Clinic Department of Orthopaedics. He will oversee the residency and fellowship programs. Dr. Richardson joined the staff in 2005 after serving his residency with Campbell Clinic and completing a Foot and Ankle Fellowship with O.L. Miller Foot and Ankle Institute at Carolinas Medial Center. He succeeds Dr. Frederick Azar, who served as Director of Education for ten years.

The Campbell Foundation’s commitment to educate the world’s finest orthopaedic surgeons is a longstanding tradition. Dr. Willis Campbell established the orthopaedic residency

program at the University of Tennessee School of Medicine in Memphis in 1924. The residency and fellowship programs have trained over 450 physicians practicing in the United States, Canada, South America, and Europe.

The residency program is an accredited five-year program for 40 residents, designed to provide each resident with a well-balanced foundation in academic and theoretical learning and practical clinical experience. Campbell Clinic offers a 12-month fellowship for talented physicians in the areas of foot and ankle surgery, sports medicine, pediatric orthopaedics, spine surgery, adult reconstruction, and trauma surgery.

Where are they going?

Front, from left: Dr. Will Crenshaw, joining a practice in Alexandria, LA Dr. Krishna Gumidyala, Spine Fellowship, University of California, San Francisco, CA Dr. Steven Hale, joining a practice in Lake Charles, LA Dr. John Weinlein, Trauma Fellowship, Minneapolis, MN

e d u c a t i o n n e w s

Resident training

program adds community

service

The University of Tennessee-Campbell Clinic Orthopaedic Residency program, supported by The Campbell Foundation, offers a careful balance between academic and theoretical learning and practical experience.

Residents in the program participate in rotations in general orthopaedics, pediatric orthopaedics, trauma, sports medicine, hand, foot and ankle, spine, adult reconstructive surgery, anatomy and pathology, and orthopedic oncology. During each rotation, residents spend approximately 50 percent of their time in clinical activities and 50 percent in surgical duties, a practice that allows residents to experience the continuity of patient care given from initial exam and evaluation, through surgical or non-surgical treatment and post-operative rehabilitation.

Now residents are taking what they have learned to students and teachers in the Memphis area.

Added to the training curriculum last year by Dr. Frederick Azar, then Director of Resident Education, the Resident Outreach program provides orthopaedic wellness information to middle and high school students in the community. With Memphis ranked as one of the most sedentary cities in the country and with high rates of obesity and diabetes, the purpose of the Resident Outreach program is to teach proper physical fitness

to young people, encouraging healthier exercise and nutrition habits for bone health. The program also gives student athletes information about injury prevention and management, over-training, and burnout. The residents encourage students to learn good habits at their early age to help prevent bone and joint conditions later in life.

Residents have spoken to hundreds of students since beginning the program last summer with presentations to the Shelby County Schools Summer Scholars program for math and science students. They spoke to student athletes and coaches at the Tennessee Middle School Athletic Conference, and this fall will participate in a series of meetings with coaches of all the various sports for City of Memphis

middle and high schools. presentations will focus on prevention and treatment of musculoskeletal injuries specific to each sport, as well as general information such as preventing infec- tions in athletes, proper nutrition, and age-appro- priate exercise programs.

In addition to schools, the Resident Outreach program hopes to visit business and civic organizations to provide bone and joint health presentations to adults.

f o u n d a t i o n n e w s

We are grateful to our generous supporters who have joined The Campbell Foundation in our efforts to advance orthopaedic medicine through surgeon education, research, and community healthcare. With your gift, The Campbell Foundation will continue to make progress toward enhancing the quality of life for our patients today and for generations to come.

As you make your charitable contributions during this season of giving, please consider The Campbell Foundation. Your gift will make a difference.

Your gift will

Help us enhance the quality of life for patients with bone and joint diseases and traumatic injuries.

Support the training of the next generation of outstanding ortho- paedic surgeons in surgical skills, research, and compassionate patient care.

Fund vital research to discover new treatments in areas such as arthritis, cartilage regeneration, joint replacement, spine and back disorders, trauma care, bone tumors, and children’s bone and joint conditions.

provide orthopaedic care to children and adults in the community regardless of their ability to pay.

Ways to give

There are a variety of ways to make a tax-deductible gift to The Campbell Foundation.

The most common gifts are cash, usually in the form of checks. You may wish to give a gift in honor of your physician, physical therapist, or other clinic staff member to express your gratitude for the excellent care you received.

Gifts are also given as memorials to loved ones or tributes to recognize a special occasion, such as a birthday, anniversary, or achievement. The Campbell Foundation will send an acknowledgement card to the family of the loved one or to the person being honored.

Many employers have matching gift programs through which your generosity to the Foundation can be multiplied.

By remembering The Campbell Foundation in your will, you can have an impact on the future of orthopaedic medicine, by supporting education and research that will provide the best care for the next generation of patients.

Your gift makes a difference

Your gift of:

$50 will provide updated publications in our library

$100 will purchase supplies for resident research projects

$250 will provide orthopaedic care to a child or adult through our community clinics

$500 will provide opportunities for Campbell residents and fellows to attend national seminars on ground- breaking orthopaedic research and treatments

$1,000 or more will help The Campbell Foundation maintain the highest level of excellence as one of the nation’s top training programs.

For informat ion

and assistance in making your gift, please contact Carol Kirby, Executive Director of Development, (901) 759-5490 or

ckirby@campbell-foundation.org.

“I am especially grateful to my doctor and the PT team for their excellent treatment, persistent therapies, and encouragement to walk again. Today I am resuming an active lifestyle.”

“Thanks to the team at Campbell Clinic, I’m walking again.”

“My gift will be used to provide training for other surgeons.”

“These doctors have my undying gratitude, appreciation, and admiration for their skill and dedication. To be healed now is a precious gift.”

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