Tethered spinal cord syndrome associated with spina bifida: clinical and radiological characteristics and indications for surgery (systematic review of the literature)

Abstract

Objective. To analyze literature data on clinical and radiation characteristics of the tethered spinal cord syndrome in spina bifida and to define criteria for indications for surgical treatment.Material and Methods. A search for prospective cohort clinical studies evaluating the clinical and radiation picture and indications for surgicalcorrection of the tethered spinal cord syndrome associated with spina bifida, published in 2005–2023 was performed in the Pubmed, EMBASE, eLibrary and the Сochrane Library databases. The literature search was carried out by one researcher. The study was carried out in accordance with the international recommendations for writing systematic reviews and meta-analyses PRISMA. The levels of evidencefor reliability and grades of the strength of recommendations were evaluated according to the ASCO Guidelines.Results. A total of 394 literature sources were found in the databases. Duplicate materials (n = 81) have been removed. When non-fulltext articles were excluded, only 28 out of 251 remained studies met the inclusion criteria and were analyzed. According to the level of evidence, 18 of them were classified as B level, and 10 – as C level.Conclusion. The components of the tethered spinal cord syndrome are a dystopic spinal cord cone, a shortened fixed filum terminale, and the presence of a lumbosacral lipoma. At the same time, there are currently no clear criteria for the integral assessment of the clinical and morphofunctional state of patients, and the available scales are not specific. The described MRI criteria are limited by the level of evidence, but despite this, they reflect a high level of consensus among experts, including that on the defining indications for surgical spinal corduntethering. The lack of clear indications for surgical intervention and the debatability of performing preventive untethering of the spinal cord require further study of the problem with an emphasis on analyzing the criteria for tethered spinal cord syndrome.