The spinal cord is a component of the body’s central nervous system, which governs the sensory and motor functions of the body under the control of the brain (see Figure 5). What would happen if such an important nerve were to be strained, or even ischemically necrotic, over a long period of time? What can be done to prevent severe trauma to the “delicate” spinal nerves? When the spinal cord is embolized, the blood supply to the spinal cord is affected and the spinal cord is constantly strained, causing two main symptoms: first, urinary and bowel dysfunction, such as urinary retention or even neurogenic bladder, constipation, pain in the perineum of the anus, etc. Over time, kidney and urinary system function will be impaired, and even fatal hazards, such as renal failure; second, motor and sensory dysfunction of the lower extremities, such as lower extremity pain or hypoesthesia, as well as lower limb movement disorders, horseshoe foot, inversion high arch foot (see Figure 6), etc., resulting in walking difficulties or even lifelong disability. Therefore, spinal cord tethering syndrome should be treated as soon as possible after diagnosis to loosen the tethered spinal cord. If left untreated, these symptoms will gradually worsen and have lifelong consequences. In particular, parents are reminded that surgery should be performed before the symptoms of spinal cord tethering syndrome become more severe or obvious, to prevent severe urinary and fecal dysfunction and deformities of the lower extremities. So, what are the specific problems that surgery can solve? Early surgical release is currently the main treatment method. The possibility of improvement of symptoms and the degree of improvement after surgery are related to many factors, including the etiology, type (especially the presence or absence of lipoma), duration of disease, surgical operation (whether the spinal cord embolism is completely released during surgery, whether the neurological function is well protected, and whether the accompanying deformity is corrected), and post-surgical care and rehabilitation. In other words, when surgery is performed early, the more thoroughly the embolism is resolved and the better the neurological function is protected, the easier it is to correct the urinary and bowel dysfunction and the accompanying deformities, and the better the overall recovery will be with good postoperative care and rehabilitation. However, if the patient has a combined lipoma, the surgery will be more difficult and the postoperative recovery will not be particularly good. If the nerve function is already damaged before surgery, such as urinary and fecal disorders and deformities of the lower limbs, the surgery may not be able to completely correct the problem, and the post-operative recovery will be slow. For patients with urinary and fecal disorders, surgery can solve most patients’ bowel problems, but only a small percentage of patients can restore normal urinary function. This group of patients can be trained to urinate and lift the anus after surgery, with appropriate rehabilitation physiotherapy and some nerve-nourishing drugs. For patients whose lower extremities have been atrophied or whose feet are dysplastic, normalcy cannot be restored by the release surgery alone, which only aims to keep the degree of deformity from getting worse. If significant clubfoot is present, orthopedic surgery can be performed after surgical release of the spinal cord. Therefore, the order of improvement after surgery is: pain relief or disappearance → recovery of sensory and motor functions → recovery of urinary and defecation functions → deformity stops aggravating and corrects itself. If the disease is detected early and treated promptly, the child can be cured. On the contrary, patients with early age of onset, heavy symptoms and late treatment have relatively poor treatment results. In some patients, surgery does not work or the disease recurs after surgery, so surgery can be repeated. However, it is best to aim for a complete release in the first surgery, which can reduce many sequelae problems.