Functional outcomes after stabilization with Dynesys in patients with spinal degenerative diseases

Objective: To know the impact of the Dynesys system on the functional outcomes in patients with spinal degenerative diseases. Summary of background data: Dynesys system has been proposed as an alternative to vertebral fusion for several spinal degenerative diseases. The fact that it has been used in people with different diagnosis criteria using different tools to measure clinical outcomes makes very difficult unifying the results available nowadays. Methods: The data base of Medlars Online International Literature (MEDLINE) via PubMed©, EMBASE©, and the Cochrane Library Plus were reviewed in search of all the studies published until November 2012 in which an operation with Dynesys in patients with spinal degenerative diseases and an evaluation of the results by an analysis of functional outcomes had taken place. No limits were used to article type, date of publication or language. Results: A total of 134 articles were found, 26 of which fulfilled the inclusion criteria after being assessed by two reviewers. All of them were case series, except for a multicenter randomized clinical trial (RCT) and a prospective case-control study. The selected articles made a total of 1507 cases. The most frequent diagnosis were lumbar spinal canal stenosis (LSCS), degenerative disc disease (DDD), degenerative spondylolisthesis (DS) and lumbar degenerative scoliosis (LDS). In cases of lumbar spinal canal stenosis Dynesys was associated to surgical decompression. Several tools to measure the functional disability and general health status were found. Oswestry Disability Index (ODI), the ODI Korean version (K-Odi), Prolo, Sf-36, Sf-12, Roland-Morris disability questionnaire (RMDQ), and the pain Visual Analogue Scale (VAS) were the most used. They showed positive results in all cases series reviewed. In most studies the ODI decreased about 25% (e.g. from a score of 85% to 60%). Better results when dynamic fusion was combined with nerve root decompression were found. Functional outcomes and leg pain scores with Dynesys were statistically non-inferior to posterolateral spinal fusion using autogenous bone. When Dynesys and decompression was compared with posterior interbody lumbar fixation (PLIF) and decompression, differences in ODI and VAS were not statistically significant. Conclusions: In patients with spinal degenerative diseases due to degenerative disc disorders, spinal canal stenosis and degenerative spondylolisthesis, surgery with Dynesys and decompression improves functional outcomes, decreases disability, and reduces back and leg pain. More studies are needed to conclude that dynamic stabilization is better than posterolateral and posterior interbody lumbar fusion. Studies comparing Dynesys with decompression against decompression alone should be done in order to isolate the effect of the dynamic stabilization.

Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies

Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectraldomain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups (P = 0.18). However, mean MP overall sensitivity was significantly higher in group A (29.05 ± 0.57 dB versus group B, 26.05 ± 2.75 dB; P < 0.001). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated (P < 0.001). Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine.