Lewis A. Sayre: the first Professor of Orthopaedic Surgery in America.

Lewis Albert Sayre (1820-1900) is considered to be among the founding fathers of orthopaedic surgery in the United States. He studied medicine at the College of Physicians and Surgeons (now of Columbia University). Sayre later helped establish the first academic department of orthopaedics at the Bellevue Medical College where he served as their first Professor of Orthopaedics. Lewis Sayre treated a considerable diversity of musculoskeletal conditions and meticulously documented them with written notes, sketches, and photographs. As a public figure, his methods were controversial, attracting praise by some and inviting criticism by other prominent members of the international community. He made great strides for physicians, helping to charter the American Medical Association and to establish the weekly publication of the Journal of the American Medical Association.

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.