ИСТИНА

The use of additional diagnostic tools allows to define the need both to prevent the "symptomatic stage" of secondary spinal cord fixation syndrome and motivates the authors and other researchers for further study and evaluation of each and every result and minimal clinical efficacy criteria. This review is the first stage for the systematic analysis of the neurosurgical treatment and "symptomatic" criteria and SM retethering efficiency in SB patients. The search for prospective cohort clinical studies was carried out 2 researches in the Pubmed, EMBASE, eLibrary and the Library databases, published in the period from 2005 - August 2022, evaluating the methods of the fixed spinal cord syndrome correction in Spina bifida. The study was carried out in accordance with the international guidelines for writing systematic reviews and meta - analyses (PRISMA). We found 23 articles published between 2009 and 1023 that have met the eligibility criteria. 17 publications were pragmatic studies by design and 5 were randomized trials. Mean level of evidence was III. Currently there was no universal and validated score, which would allow to assess neurologic, urodynamic and orthopedic outcomes of detethering surgery. Functional assessment by the use of tractography was seen in 19 out of 23 articles. That indicates the emerging consensus among the experts. Conclusions Currently there is a consensus among the experts regarding clinical and neuro visualization criteria of tethered cord syndrome. Despite that, the question of surgical effectiveness directly depends on methods of clinical evaluation used to assess severity of functional deficit (that includes voiding function) and to what degree morphofunctional alterations to neural tissue are reversible. Despite the abundance of clinical scores and questionnaires in literature currently there is no universally implemented system for standardized evaluation of neurologic, urologic and orthopedic deficits in patients with tethered cord syndrome.