FEATURES OF SURGICAL TREATMENT OF THE SYNDROME OF FIXED SPINAL CORD IN CASE OF CLOSED SPINAL DYSRAPHISM

Objective: This study aims to evaluate the outcomes and surgical approaches in the treatment of tethered cord syndrome (TCS) associated with closed spinal dysraphism in pediatric patients. Methods: A total of 61 children with TCS underwent microsurgical untethering procedures between 2019 and 2022. Preoperative diagnostics included MRI, MSCT, ENMG, and tractography. Surgical interventions incorporated laminectomy, resection of lipomas or dermal sinuses, and dissection of arachnoid and fibrous adhesions using intraoperative neurophysiological monitoring. Outcomes were compared with a retrospective control group of 55 patients. Results: The most common pathologies were lipomeningocele (63.9%), spina bifida (27.8%), dermal sinus (14.7%), and thickened filum terminale (9.8%). Neurological improvement was observed postoperatively, especially in pelvic dysfunction (29.5%) and motor deficits (19.6%). Intraoperative neurophysiological monitoring played a crucial role in preserving neurological function. Duraplasty contributed to reducing the risk of retethering. Conclusion: Early surgical intervention with precise microsurgical techniques and real-time neuromonitoring significantly improves neurological outcomes in children with TCS. Comprehensive defixation, including filum terminale and associated adhesions, along with duraplasty, is essential for long-term success.