The spinal cord is initially tethered to the spinal segments, and during growth and development the caudal end of the spinal cord moves towards the cephalic end relative to the spinal column, and the end of the spinal cord in normal adults should be at the level of the 12 thoracic to 1 lumbar spine. Spinal cord tethering syndrome is a condition in which the spinal cord is tethered and fixed for various reasons and cannot reach its normal position. Causes include congenital factors (e.g. developmental malformations due to viral infections in early pregnancy, folic acid deficiency, etc.) and acquired factors (e.g. lumbosacral spinal canal surgery). Tethering can be seen in all parts of the spinal cord, but is most commonly seen at the end of the spinal cord, where the lower end of the spinal cord is tethered and fixed. Ischemic pathological changes occur when the spinal cord is tethered, resulting in a spectrum of neurological dysfunction and limb deformity syndromes. The most common clinical condition is congenital tethering of the spinal cord. Clinical manifestations of spinal cord tethering syndrome: The symptoms of spinal cord tethering syndrome are related to factors such as ischemia and hypoxia of the spinal cord. For the common spinal cord terminal tethering, the symptoms of the patient are mainly focused on the lower limbs and the function of urination and defecation because this part of the nerve innervates the motor, sensory and urinary functions of the lower limbs. Local skin abnormalities: Since the disease is often caused by developmental malformations, many patients can be found at birth with skin masses in the lumbosacral region, abnormal hair growth, pigmentation and even skin depressions or sinus tracts. Skin masses can increase with age, while sinus tracts can have flowing water, secretions and other conditions. 2, urinary and faecal dysfunction: urinary dysfunction can be manifested as urinary difficulties, urinary retention, urinary incontinence, inability to hold urine, etc., stool dysfunction can be manifested as constipation, inability to hold stool and other situations. In children, it can only be manifested as urine loss, especially in infants and toddlers with no expression ability. 3, lower limb muscle weakness: can be manifested as unilateral or bilateral limb strength weakness, long-term force weak patients may even appear muscle atrophy. If the weakening of the muscles of the lower limbs is obvious, it can affect the walking posture of the patient, appearing to walk with dragged legs, walking with raised legs, etc. 4, lower limbs and lumbosacral pain and hyperalgesia: can be manifested as unilateral or bilateral limbs, lumbosacral or even around the anus numbness, pain or even sensory impairment (hyperalgesia), some patients will appear because of the hyperalgesia and burn, stabbing without feeling pain themselves. 5.Lower limb deformity: It can be manifested as high arched foot, horseshoe foot and other lower limb deformities, which affect the normal activities of patients. The above symptoms can appear at a young age, or in adulthood. It can be significantly aggravated during the stage of rapid height development of the affected children. The examination of spinal cord tethering syndrome: 1.X-ray examination: the bone quality of the lumbosacral area can be understood, and most of the affected children can be seen to have lumbosacral vertebral fracture. 2, CT examination: If the patient’s spinal developmental deformity is complex, preoperative CT scan and three-dimensional reconstruction of the lumbar spine can be done to further understand the bone quality, in order to guide the access and steps of surgery. 3, MRI examination: MRI should be used as the first choice to clarify the spinal cord tethering, which can detect low spinal cord cone position, thickened end filaments, spina bifida, spinal cord spondylolisthesis, intraspinal lipoma, teratoma, etc.. The distribution of the spinal cord and nerve roots can also be understood. 4.Inspection of urinary and fecal functions: including ultrasound measurement of bladder residual urine, urodynamics and recto-anal manometry, etc. 5.Other tests: electromyography of the lower limbs can be done according to the situation. Treatment of spinal cord tethering syndrome: Before discussing the treatment of spinal cord tethering syndrome, it is important to clarify three points: first, since all neurons are not regenerable, the purpose of surgery is to prevent further aggravation of symptoms, so early treatment is very important; second, not all spinal cord ends in a low position are spinal cord tethered, if the spinal cord is not significantly low in adults and there are no related symptoms, surgery is not required. Third, when spina bifida and spinal cord tethering are combined with spinal cord tethering, removal of the subcutaneous mass alone will not resolve the tethering of the spinal cord. As the spinal cord develops and bending activities increase with age, the nerve damage is progressively aggravated. Therefore, early diagnosis and treatment of spinal cord tethering syndrome is very important. If the diagnosis of spinal cord tethering (not spinal cord hypoplasia) is confirmed, the sooner surgery is performed, the better. Currently, the only effective treatment is spinal cord tethering release surgery. Some parents of children are afraid of the risk of surgery and choose various non-surgical treatments, which eventually lead to irreversible neurological dysfunction. Patients with symptoms should be operated as soon as possible. In the case of simple spinal cord hypoplasia, the patient’s symptoms should be observed, and surgery should be performed as soon as spinal cord tethering symptoms appear. However, spinal cord lipoma, teratoma, and other combined spinal cord hypoplasia should be operated when asymptomatic. As a result, early examination of lumbosacral masses, abnormal hair growth, pigmentation and even skin depressions or sinus tracts is necessary to clarify the presence of spinal cord tethering and provide timely treatment.