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.

Perfil sociodemográfico del feminicidio en España y su relación con las denuncias por violencia de pareja

Objetivo: Analizar las características asociadas al riesgo de feminicidio en España entre mujeres expuestas a la violencia de pareja o análogo y su posible asociación con las denuncias a los agresores. Métodos: Se realizó un estudio de casos y controles para el periodo 2010-2011. Los casos, 135 mujeres mayores de edad, asesinadas por su pareja o análogo durante dicho periodo, se identificaron a través de la página web de la Federación de Asociaciones de Mujeres Separadas y Divorciadas, y de los informes del Consejo General del Poder Judicial. Los controles, 185 mujeres expuestas a la violencia de pareja el último año, proceden de la Macroencuesta de Violencia de Género 2011. La asociación entre la denuncia y el riesgo de feminicidio se estimó mediante modelos de regresión logística multivariada. Resultados: No se encontró asociación entre denunciar al agresor y el riesgo de ser asesinada (odds ratio [OR]: 1,38; intervalo de confianza del 95% [IC95%]: 0,68-2,79). Las mujeres inmigrantes expuestas a la violencia de pareja registraron una mayor probabilidad de ser asesinadas (ref.: mujeres españolas; OR: 5,38; IC95%: 2,41-11,99). Esta asociación también se observó en las mujeres que vivían en zonas rurales (ref: zonas urbanas; OR: 2,94; IC95%: 1,36-6,38). Conclusiones: La denuncia judicial al agresor no parece modificar el riesgo de asesinato entre las mujeres expuestas a la violencia de pareja. Las medidas de protección a las mujeres deberían extremarse en las mujeres inmigrantes y las que viven en el medio rural.