Evaluation of the outcomes of neurosurgical and orthopedic interventions in spinal dysraphism syndrome from the perspective of the dynamics of objective diagnostic criteria for spinal cord tethering and traction syndrome

Objective. To evaluate the diagnostic value of clinical and instrumental criteria for tethered cord syndrome (TCS) by analyzing the outcomes of the main types of neurosurgical and orthopedic interventions.

Material and Methods. The retrospective continuous 3-center study included 120 patients operated for TCS in spinal dysraphism. Based on functional outcome assessment, patients were divided into three groups: patients in Group 1 underwent microsurgical redetethering, in Group 2 – shortening three-column vertebrotomy (Schwab 3–6) with correction of spinal deformity and instrumental fixation; and in Group 3 (control) – without reoperation. Groups were assessed for the nosological structure of dysraphism based on the neurosegmental level of damage according to Sharrard, frequency of surgical interventions, dynamics of motor status and spasticity according to the Ashworth scale, sensory impairment, urinary control and bladder tone according to urodynamic studies, MR signs of spinal cord tethering syndrome, types of musculoskeletal deformities, as well as treatment outcomes according to uniform assessment criteria.

Results. Statistically significant differences in the frequency of unfavorable outcomes depending on the type of surgery were shown. Redethetering was associated with an increased risk of unfavorable outcome (61%; p = 0.044), shortening vertebrotomy showed significant predominance of favorable outcome (p = 0.036): 7% unfavorable versus 27% favorable. Analysis of the initial diagnosis did not reveal significant differences between the study groups in terms of the types of dysraphism and neurosegmental level of damage, nosological structure, motor status assessment, the number of interventions performed to eliminate spinal cord tethering, as well as the frequency of spinal deformities. At the same time, the analysis of lower extremity pathology revealed statistically significant differences in patients with kyphosis (p < 0.01), leg deformities (p = 0.019), and hip dislocation (p = 0.001).

Conclusion. Redetethering in spinal dysraphism syndrome is associated with an increased risk of adverse outcomes; shortening vertebrotomy demonstrates the best results. Key prognostic factors for adverse outcomes are significant orthopedic deformities, including foot deformities and hip dislocations, which reflect the severity of damage to neural structures and serve as clinical markers for risk stratification. It is advisable to personalize unification of conventional approaches to treating tethered cord syndrome in spinal dysraphism; the interdisciplinary nature of the problem requires the development of standardized algorithms for managing these patients.

1. Weisbrod LJ, Thorell W. Tethered Cord Syndrome (TCS). Treasure Island (FL). StatPearls Publishing, 2025. [Electronoc resource]. URL: https://www.ncbi.nlm.nih.gov/books/NBK585121. Accessed on 2023 Jul 31.

2. Хачатрян В.А., Сысоев К.В. Об актуальных проблемах патогенеза, диагностики и лечения синдрома фиксированного спинного мозга (аналитический обзор). Нейрохирургия и неврология детского возраста. 2014;(3):76. [Khachatryan VA, Sysoev K. Current issues of pathogenesis, diagnostics and treatment of the tethered spinal cord syndrome (analytical review). Neurosurgery and Neurology of Childhood. 2014;(3):76]. EDN: SYOZVH

3. Lima R, Monteiro A, Salgado AJ, Monteiro S, Silva NA. Pathophysiology and therapeutic approaches for spinal cord injury. Int J Mol Sci. 2022;23:13833. DOI: 10.3390/ijms232213833

4. Рябых С.О., Горчаков С.А., Калашников А.А. Синдром фиксированного спинного мозга при spina bifida: клинико-лучевая характеристика и показания к оперативному вмешательству (систематический обзор литературы). Хирургия позвоночника. 2024;21(1):27–34. [Ryabykh SO, Gorchakov SA, Kalashnikov AA. Tethered spinal cord syndrome associated with spina bifida: clinical and radiological characteristics and indications for surgery (systematic review of the literature). Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2024;21(1):27–34]. DOI: 10.14531/ss2024.1.27-34 EDN: HHGVIT

5. Сысоев К.В., Тадевосян А.Р., Назинкина Ю.В., Хачатрян В.А. Результаты хирургического лечения детей с синдромом фиксированного спинного мозга. Прогноз на основании данных спинальной 3Тл МРТ-трактографии. Вопросы нейрохирургии им. Н.Н. Бурденко. 016;80(3):66–73. [Sysoev KV, Tadevosyan AR, Nazinkina YuV, Khachatrian VA. Surgical treatment outcomes in children with tethered spinal cord syndrome. A prognosis on the basis of spinal 3T MRI tractography. Burdenko’s Journal of Neurosurgery. 2016;80(3):66–73]. EDN: WDOXAH

6. Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus. 2001;10:e1. DOI: 10.3171/foc.2001.10.1.2

7. Магомедов Ш.Ш., Татаринцев А.П., Сысоев К.В., Докиш М.Ю. Значение растяжения спинного мозга в формировании спондилогенной цервикальной миелопатии на фоне кифотической деформации позвоночника. Вопросы нейрохирургии им. Н.Н. Бурденко. 2018;82(5):62–68. [Magomedov ShSh, Tatarintsev AP, Sysoev KV, Dokish MYu. The effect of spinal cord stretching on developent of spondylogenic cervical myelopathy associated with kyphotic spinal deformity. Burdenko’s Journal of Neurosurgery. 2018;82(5):62–68]. DOI: 10.17116/neiro20188205162 EDN: VLFVCO

8. Hussein NA, Ahmed KA, Osman NM, Yacoub GEE. Role of ultrasonography in screening of spinal dysraphism in infants at risk. Egypt J Radiol Nucl Med. 2022;53:46. DOI: 10.1186/s43055-022-00722-2

9. Абдуллаев Д.Е., Югай И.А., Ахмедиев М.М., Эргашев О.Ф. Особенности хирургического лечения пациентов с синдромом фиксированного спинного мозга при закрытом спинальном дизрафизме. Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2022;17(2):32–35. [Abdullaev DE, Yugay IA, Ahmediyev MM, Ergashev OF. Fetures of surgical treatment of the fixed spinal cord syndrome with closed spinal dysraphism. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(2):32–35]. DOI: 10.25881/20728255_2022_17_2_32 EDN: OQMVRR

10. Еликбаев Г.М. Результаты нейрохирургических вмешательств у детей со спинальными дизрафиями и методика оценки исходов. Медицина и качество жизни. 2011;(4):22–23. [Elikbaev GM. Results of neurosurgical interventions in children with spinal dysraphism and outcome assessment methods. Medicine and Quality of Life. 2011;(4):22–23].

11. Sharrard WJ. Spinal osteotomy for congenital kyphosis in myelomeningocele. J Bone Joint Surg Br. 1968;50:466–471.