Neurosurgery Spine Program, University of Southern California, Los Angeles, California.
Southern California Evidence Review Center, University of Southern California, Los Angeles, California.
Pediatrics. 2024 Nov 1;154(5). doi: 10.1542/peds.2024-068270.
Tethered cord syndrome is associated with motor and sensory deficits.
Our objective was to summarize evidence regarding the diagnosis, prophylactic surgery, symptomatic treatment, and repeat surgery of tethered spinal cord in a systematic review (CRD42023461296).
We searched 13 databases, reference-mined reviews, and contacted authors to identify diagnostic accuracy studies and treatment studies published until March 2024.
One reviewer abstracted data, and a content expert checked the data for accuracy. We assessed the risk of bias, strength of evidence (SoE), and applicability.
The evidence base includes 103 controlled studies, many with risk of bias and applicability concerns, and 355 case series providing additional clinical information. We found moderate SoE for MRI diagnosing tethered spinal cord, with medium to high diagnostic sensitivity and specificity. A small number of prophylactic surgery studies suggested motor function benefits and stability of neurologic status over time, but also complications such as surgical site infection (low SoE). A larger body of evidence documents treatments for symptomatic patients; studies revealed improvement in neurologic status after surgical detethering (low SoE), but also postoperative complications such as cerebrospinal fluid leakage (moderate SoE). A small body of evidence exists for retethering treatment (low or insufficient SoE for all outcomes).
There was insufficient evidence for key outcomes (eg, over- or undertreatment, clinical impact of diagnostic modalities, ambulation, quality of life).
This comprehensive overview informs difficult clinical decisions that parents and their children with tethered spinal cords, as well as their health care providers, face.
脊髓栓系综合征与运动和感觉功能障碍有关。
我们旨在对脊髓栓系的诊断、预防性手术、症状性治疗和再次手术进行系统评价，总结相关证据（CRD42023461296）。
我们检索了 13 个数据库、综述参考文献，并与作者联系以确定发表至 2024 年 3 月的诊断准确性研究和治疗研究。
一位评审员提取数据，一位内容专家检查数据的准确性。我们评估了偏倚风险、证据力度（SoE）和适用性。
该证据基础包括 103 项对照研究，其中许多研究存在偏倚和适用性问题，355 项病例系列研究提供了更多的临床信息。我们发现 MRI 诊断脊髓栓系的 SoE 为中等，具有中等到高的诊断敏感度和特异性。少数预防性手术研究表明运动功能有获益，神经状态随时间稳定，但也存在并发症，如手术部位感染（SoE 较低）。大量证据记录了对症患者的治疗方法；研究表明，脊髓松解术后神经状态改善（SoE 较低），但也存在术后并发症，如脑脊液漏（SoE 中等）。关于再次栓系的治疗，证据很少（所有结局的 SoE 均为低或不足）。
关键结局的证据不足（例如，过度或治疗不足、诊断方式的临床影响、步行能力、生活质量）。
本综述全面概述了脊髓栓系患儿及其家长以及他们的医疗保健提供者面临的困难临床决策。
