Spinal tethering syndrome may be congenital (e.g., viral infection in the mother during early pregnancy, insufficient vegetable intake and severe folic acid deficiency, etc.) or acquired (e.g., lumbosacral spinal canal surgery), etc. During growth and development, the spinal canal grows at a greater rate than the spinal cord, and therefore the lower end of the spinal cord gradually rises in comparison to the lower end of the vertebral canal The lower end of the spinal cord is tethered and fixed, and the spinal cord is strained by the occurrence of ischemic pathology, resulting in a series of neurologic dysfunctions and malformations. The spinal cord is pulled and ischemic pathological changes occur, resulting in a series of neurological dysfunctions and malformations. The neurologic damage progressively worsens with age, spinal cord development, and increased bending. Spinal cord tethering is a condition in which the lower end of the spinal cord is constrained at the end of the spinal canal for a variety of reasons and fails to rise normally, leaving it in a lower-than-normal position. It is one of the major pathologic mechanisms for neurologic symptoms resulting from a variety of congenital developmental anomalies, and the resulting series of clinical manifestations is known as spinal cord tethering syndrome. Etiology A variety of congenital developmental anomalies of the spinal cord and spinal cord ends can lead to tethering of the spinal cord, such as occult spina bifida, spinal bulge, spinal cord bulge, spinal cord end-filament tension, lumbosacral intraspinal lipomas, congenital cysts, and subterranean hairy sinus, and so on. In addition to the aforementioned congenital factors, postoperative adhesions to the lumbosacral spinal bulge can also lead to re-tethering of the spinal cord. It is generally believed that tethering of the spinal cord results in impaired blood circulation to the end of the spinal cord, leading to corresponding neurological symptoms. Clinical manifestations The clinical manifestations of spinal cord tethering syndrome (SCTS) are similar to those of spina bifida, and include the following: Skin changes in the lumbosacral region: Lumbosacral skin bulges or depressions, which may be accompanied by secretions or infections; hirsuteness; and large, elevated masses. These are indicative of occult spina bifida, latent hairy sinus, spinal bulge, etc., and may be associated with spinal cord tethering. Motor disorders of the lower limbs: These include abnormal walking, weakness, deformity and pain in the lower limbs, and may be associated with scoliosis. Sensory disorders of the lower limbs: manifested by abnormal sensation and pain in the lower limbs, perineum and lower back. Urinary and fecal dysfunction: Commonly manifested as urinary retention, difficulty in urination, urinary incontinence, frequent urination, less than normal amount each time, etc.; constipation, constipation, or incontinence. Diagnosis and examination Magnetic resonance imaging (MRI) is the main method of diagnosing spinal cord tethering, which can not only clarify the presence or absence of spinal cord tethering, but also understand the coexisting other pathological changes, such as lipomas, longitudinal fissures of the spinal cord, etc. X-rays can determine the presence or absence of spina bifida. Ultrasound of the urinary tract and urodynamics are performed in conjunction with urinary and bowel function to evaluate the degree of urinary tract involvement and spinal cord neurologic impairment. Treatment Spinal cord tethering has already undergone organic changes by the time symptoms appear, and we cannot normalize it, but can only correct it appropriately so that it does not continue to develop. Symptoms of tethered spinal cord syndrome may be caused by destructive damage to the nervous system, which is usually irreparable, and treatment is simply a matter of keeping the damage from worsening. Symptoms may also be the result of irritating or incomplete damage to the nervous system, in which case surgical treatment may have the dual effect of reducing symptoms and preventing progression of the disease. Therefore, the fundamental goal of surgical treatment of spinal cord tethering syndrome is to prevent further progression of the disease, which may result in improvement of motor and sensory function of the lower extremities, and even bowel and bladder function in some patients. In general, the presence of urinary and fecal dysfunction is often indicative of a poor prognosis. Surgery usually does not improve urinary and fecal dysfunction, deformity of the lower limbs and feet, but may improve pain and incomplete muscle weakness to some extent. Deformities of the lower extremities and feet may be partially improved by orthopedic surgery. Therefore, for many patients with spinal tethering syndrome, especially children, a combination of spinal spine surgery or neurosurgery, urology, and orthopedic orthopedics is required. For patients with normal bowel and bladder function, including those with lumbosacral skin changes and sensory and motor deficits in the lower extremities, we recommend early and systematic examination, evaluation, and surgery; for those with bowel and bladder dysfunction, surgery should be chosen in the context of the patient’s systemic condition and the relevant investigations, and the vast majority of these patients can and do require surgery. The purpose of surgery is to release the tethering of the lower end of the spinal cord and prevent further progression of the disease. After surgery, some of the children showed some improvement in their symptoms. The degree of improvement is as follows: pain relief or disappearance, recovery of sensory-motor function, recovery of urination and defecation function, stop of deformity aggravation and self-correction. If the disease is detected early and treated in time, the child can be cured. On the contrary, cases with early age of onset, severe symptoms and late treatment have relatively poor outcomes. Some of those who are not cured or have recurrence of the disease after surgery can be operated again. We found that some children had been operated on before, but only the large bag in the lumbosacral area (i.e., bulging spinal sac and lipoma) was removed without dealing with the spinal cord lesions in the spinal canal, which was actually equivalent to “cosmetic” surgery on the lumbosacral area, and the result was ineffective or aggravated; even some doctors thought that the disease was untreatable and waited passively for the disease to develop. Even some doctors believe that the disease is untreatable and wait passively for the development of the disease, which is a painful lesson. When operating on patients, the concept of minimally invasive surgery should be implemented, and microsurgery should be insisted on, together with neurophysiological monitoring if necessary, in order to completely release the tethering as much as possible, avoid nerve damage, reduce re-adhesion and tethering, as well as to prevent postoperative wound complications. Postoperative patients are followed up with as much guidance as possible on the prevention and treatment of urinary tract dysfunction, motor and sensory rehabilitation of the lower extremities, and correction of lower extremity deformities. We believe that focusing solely on tethering surgery and neglecting to provide proper guidance for the continued management of these dysfunctions is detrimental to the patient.