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Resumen La evaluacion economica de las tecnologias sanitarias se esta convirtiendo en una prioridad para los sistemas de salud. Es una de las razones por las que la llamada Medicina Basada en la Evidencia esta en plena actualidad y tiene una importancia cada vez mayor. En este trabajo se aborda el problema del estudio de la literatura cientifica. La obtencion de evidencias resulta en muchas ocasiones complicado debido a la ingente cantidad de ensayos clinicos, a las limitaciones de las principales bases de datos, etc., por lo que el medico recibe muchas veces resultados contradictorios. Actualmente las revisiones sistematicas (como las realizadas por la Colaboracion Internacional Cochrane) estan aportando los mas altos niveles de evidencias sobre la eficacia de regimenes preventivos, terapeuticos y rehabilitadores, pudiendo proporcionar al medico rehabilitador que lo desee una guia de extraordinaria utilidad. Aunque asumiendo sus imperfecciones, la Medicina Basada en la Evidencia, junto con la experiencia y conocimientos clinicos del medico, puede llevar a una mejor, mas racional y estimulante practica de la medicina aunando los intereses colectivos con los individuales.

Resumen.—Hacemos una revision bibliografica de las revisiones sistematicas y metaanalisis publicados que hacen referencia a la eficacia analgesica de la electroterapia. Resumimos estos trabajos y discutimos sus resultados y conclusiones. Aunque existen resultados positivos, la mayor parte de estas revisiones, salvo en determinados casos, no parecen confirmar la eficacia analgesica de la electroterapia y sus posibles beneficios parecen, en general, de escasa relevancia; dado que tampoco existe una definitiva evidencia de su ineficacia, son necesarios estudios mas rigurosos para obtener conclusiones definitivas.

Objective: To study the clinical evolution and the functional outcome of patients suffering from spinal cord infarction who were treated at the Spinal Cord Injuries Unit. To try to determine the factors that could have influence in their functional outcome. Setting: In a Spinal Cord Injuries Unit, regionally-based, and which forms part of a general hospital with a high level of specialization. Method: Retrospective study of the medical records of patients suffering from vascular spinal cord ischemia, as acute anterior spinal artery syndrome or associated with aortic surgery or rupture. Cases that were due to compressive, tumoral or inflammatory pathologies were excluded. Assessment of the neurological syndrome followed the ASIA/IMSOP criteria. Age, sex, history and magnetic resonance imaging (MRI) findings were analyzed. Assessment of functional outcome was made regarding ambulatory ability or wheelchair use, and bladder/sphincter control. Results: Thirty-six cases were selected, the commonest group being spinal cord ischemia due to idiopathic causes (36.1%). Following these, there were cases associated with aortic surgery (25%), systemic arteriosclerosis (19.4%) and acute deficit of perfusion (11.1%). The average age of the patients was 59.3 years, with a mortality of 22.2% during the hospital stay. Regarding the functional outcomes at the moment of discharge, it must be pointed out that 57.1% of the patients were wheelchair users, 25% were ambulatory, using technical aids, and 17.9% were fully ambulatory. The group who could perform some kind of walking was significantly younger than the group of wheelchair users (48.17 vs 61.38 years). Additionally, it became evident that those patients who did not show voluntary muscle contraction at the time of admission (ASIA groups A and B) presented a higher risk of being wheelchair users. Conclusion: Acute spinal cord ischemia syndrome has a severe prognosis with permanent and disabling sequelae. Initial neurological assessment following ASIA/IMSOP classification proves to be the best predictor of prognosis, and the patient's advanced age constitutes a negative factor for functional recovery. Spinal Cord (2001) 39, 520–525.