PubMed Health⌕ Search

Biomedical subjects

John F Sarwark

Publications and source records attributed to John F Sarwark.

7 recordsLinked to original sources
PubMed2006

Congenital and developmental deformities of the spine in children with myelomeningocele.

The treatment of spinal deformities in children with myelomeningocele poses a formidable task. Multiple medical comorbidities, such as insensate skin and chronic urinary tract infection, make care of the spine difficult. A thorough understanding of the natural history of these deformities is mandatory for appropriate treatment to be rendered. A team approach that includes physicians from multiple specialties provides the best care for these patients. The two most challenging problems are paralytic scoliosis and rigid lumbar kyphosis. The precise indications for surgical intervention are multifactorial, and the proposed benefits must be weighed against the potential risks. Newer spinal constructs now allow for fixation of the spine in areas previously difficult to instrument. Complications appear to be decreasing with improved understanding of the pathophysiology associated with myelomeningocele.

Bone Diseases, Developmental↗
PubMed2005

Infant and child motor development.

Identifying infant and child developmental delay is a skill important for orthopaedic surgeons to master because they often are asked to distinguish between normal and abnormal movement. An emphasis has been placed on early detection and referral for intervention, which has been shown to enhance the lives of the infant or child and his or her family. Appropriate recognition of delay is necessary for referral to early intervention services, which serve to help these children overcome or improve motor dysfunction and to help families grow more confident in caring for children with special needs. We define early intervention, discuss normal and abnormal motor development, and provide useful examination tools to assess motor development.

Age Factors↗
PubMed2003

The surgical management of pediatric fractures of the upper extremity.

The vast majority of pediatric fractures of the upper extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures. In the past 2 decades, surgical management of certain fractures (e.g., percutaneous pinning of displaced supracondylar fractures) has provided better results than closed management. Surgical management is clearly indicated for certain injuries, such as those requiring anatomic realignment of the physis or articular surface. Increasingly, however, surgical management is being used to maintain optimal alignment or to allow early motion. In many such cases, both nonsurgical and surgical methods have yielded good results and have vocal advocates. Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for surgical management of pediatric fractures.

Adolescent↗
PubMed2002

A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis.

STUDY DESIGN: The lumbar sacropelvis in 11 patients with myelomeningocele and kyphosis was treated with a subtraction kyphectomy technique and posterior instrumentation. The results of this procedure in the 11 patients were evaluated and compared with previous results. OBJECTIVE: To examine critically their experience using the subtraction (decancellation) vertebrectomy technique combined with posterior instrumentation for myelomeningocele kyphosis, the authors reviewed the charts of 18 myelomeningocele patients who underwent surgery for lumbar kyphosis between 1994 and 1998. SUMMARY OF BACKGROUND: The benefits of restoring sagittal spinal alignment in myelomeningocele patients with severe lumbar kyphosis deformity to achieve postural stability and improved sitting balance generally are accepted. The optimal method of deformity correction, the extent of instrumentation, and the role of limited arthrodesis remain undefined. METHODS: Of the 18 patients considered, 11 met the inclusion criteria of having undergone reconstruction using a subtraction (decancellation) vertebrectomy technique, preservation of the thecal sac, limited arthrodesis with posterior transpedicular lumbosacral instrumentation, and a minimum follow-up evaluation of 2 years. The study considered the age of the patient, number of levels fused, estimated blood loss, preoperative deformity, immediate postoperative correction, magnitude of correction, and maintenance of correction at latest follow-up assessment. RESULTS: The average age at the time of the index procedure was 6 years (range, 3-12 years). The average preoperative kyphosis was 88 degrees (range, 50-149 degrees ). Immediately after surgery, the average curve measurement was 3 degrees lordosis (range, 50 degrees to 50 degrees ). The average magnitude of postoperative sagittal plane deformity correction was 91 degrees (range, 43-126 degrees ). Finally, the magnitude of correction maintained at the final follow-up assessment averaged 66 degrees (range, 22-114 degrees ). This represented an average loss of correction at 2 years of 24 degrees (range, 0-84 degrees ). There were no deaths, episodes of acute-onset hydrocephalus, vascular complications, or chronic deep wound infections. CONCLUSIONS: The subtraction (decancellation) vertebrectomy technique with preservation of the dural sac is a safe and efficacious technique for correction and stabilization of myelomeningocele kyphosis in young patients. Morbidity is reduced, as compared with that of excision techniques. Restoration of sagittal alignment at the time of initial correction and stabilization to achieve a balanced spine led to acceptable results.

Blood Loss, Surgical↗