Spinal cord tethering: First, let’s understand the physiological knowledge: during the growth and development of a baby, the spinal cord located in the spinal canal grows faster, so the lower end of the spinal cord rises gradually relative to the lower end of the spinal canal. Spinal cord tethering means that the lower end of the spinal cord is tethered to the end of the spinal canal for various reasons and cannot rise normally, making its position lower than normal. When the baby grows up, the spinal cord is forcibly stretched, resulting in ischemic necrosis of the nerves. The nerve is one of the most delicate tissues in the body and once necrosis occurs it cannot be regenerated. So is spinal cord embolism as occult spina bifida really an invisible trap? Of course not, parents can detect it early through various clues. Babies with spinal embolism usually have the following back abnormalities: small depressions, bumps or hairy orifices in the lumbosacral region; prune-like hemangiomas on the midline of the lumbar spine; asymmetrical intergluteal cleft; abnormal hirsutism in the back; subcutaneous lipomas; and parchment-like skin. The following figure was taken during our surgery, typical small depression in the lumbosacral area The following figure shows typical lumbosacral bulge and skin hirsutism, as well as MRI image of the spinal cord being stretched: Clinical manifestations of spinal cord embolism: Spinal cord embolism syndrome 1. Pain: Mostly seen in adolescent children and adults, pain in the lower back, often radiating to one or both lower limbs. The pain in the lower back often radiates to one or both lower extremities. The trunk is limited by forward flexion and touching the toes. 2. Neurological system: weakness or sensory loss in the lower limbs, defective ankle joint movement, hyperreflexia or hyporeflexia. 3.Urinary system: urinary incontinence and recurrent urinary tract infection. 4.Somatic deformity: foot deformity (asymmetry, claw toe, inversion, hollow concave foot), scoliosis. The above clinical manifestations will worsen as the baby grows up, such as urinary incontinence and recurrent urinary tract infections caused by the strain on the nerves of the urinary system, which eventually leads to uremia and loss of both kidney functions, which cannot be recovered even by kidney replacement; another example is that a baby or an adult without any symptoms is paralyzed half of the body immediately after a sudden fall or being hit, and only after further examination is it found that there is a spinal cord embolism disease, and the spinal cord that is firmly tethered is The spinal cord, which is firmly tethered to the body, ruptures under the sudden violent impact, leading to an irreversible end. Diagnosis: Most spinal cord embolism is due to the end of the spinal cord being held in place by lipoma-like tissue in the sacrococcygeal region. The disease is clearly diagnosed by ultrasound and MRI. The end filaments may even terminate in scattered distended lipomas. Early surgical treatment should be performed in children with symptoms of spinal cord embolism. Prophylactic surgery is particularly emphasized in infants with simple hypertrophic fatty filaments causing spinal cord embolism. Long-term outpatient follow-up, including periodic urodynamic screening, is available for children without spinal cord embolism. The purpose of surgical treatment: 1. Release the spinal cones of the abnormal end filament embolism. 2. Removal of lipomas inside and outside the spinal cord. The prognosis after spinal cord embolization release is good with few complications, and the intraoperative disconnected spinal cord terminal filaments rarely re-embolize. Postoperative pain is reduced and bladder function is improved, but motor impairment is difficult to improve. Therefore, it is still important to advocate early consultation and early treatment to avoid permanent damage to the baby from nerve injury.