CONTEXT Tethered cord syndrome is associated with motor and sensory deficits. OBJECTIVE 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). DATA SOURCES AND STUDY SELECTION We searched 13 databases, reference-mined reviews, and contacted authors to identify diagnostic accuracy studies and treatment studies published until March 2024. DATA EXTRACTION 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. RESULTS 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). LIMITATIONS There was insufficient evidence for key outcomes (eg, over- or undertreatment, clinical impact of diagnostic modalities, ambulation, quality of life). CONCLUSIONS This comprehensive overview informs difficult clinical decisions that parents and their children with tethered spinal cords, as well as their health care providers, face.

中文翻译：

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脊髓栓系的诊断和治疗：系统评价。


背景 脊髓栓系综合征与运动和感觉缺陷有关。目的 我们的目的是在系统评价 （CRD42023461296） 中总结有关栓系脊髓诊断、预防性手术、对症治疗和重复手术的证据。数据来源和研究选择 我们检索了 13 个数据库、参考文献综述，并联系了作者，以确定截至 2024 年 3 月发表的诊断准确性研究和治疗研究。资料提取 一名评价员提取数据，一名内容专家检查数据的准确性。我们评估了偏倚风险、证据强度（strength of evidence ， SoE）和适用性。结果 证据基础包括 103 项对照研究，其中许多存在偏倚风险和适用性问题，以及 355 个病例系列，提供额外的临床信息。我们发现 MRI 诊断脊髓栓系的 SoE 为中度，具有中到高的诊断敏感性和特异性。少量预防性手术研究表明，随着时间的推移，运动功能有益和神经系统状态的稳定性，但也存在并发症，如手术部位感染（低 SoE）。更多的证据记录了对有症状患者的治疗;研究显示，手术脱离后神经功能状态有所改善 （low SoE），但术后并发症如脑脊液渗漏 （中度 SoE） 也有所改善。有少量证据表明 retethering 治疗（所有结局的 SoE 低或不足）。局限性 关键结局（如过度治疗或治疗不足、诊断方式的临床影响、行走、生活质量）的证据不足。 结论 这份全面的概述为患有脊髓栓系的父母及其孩子以及他们的医疗保健提供者面临的困难临床决策提供了信息。