Tethered cord syndrome is a progressive anomaly resulting in neurological, orthopedic and urological dysfunction caused by the anchoring of the spinal cord by deferent pathologies. The underlying pathophysiological processes include decreased blood flow impaired oxidative metabolism and abnormal glucose metabolism. Objective: To evaluate clinical outcome of surgical detethering for cases of tethered cord syndrome at Al-Azhar University Hospitals. Patients and Methods: We worked on 25 cases

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... s and children with symptomatic tethered cord syndrome operated by microscopic detethering and treatment of the associated pathology using intraoperative neurophysiologic monitoring at Al-Azhar university hospitals between February 2017 and October 2020 and follow up was done forat least6 months postoperatively. All cases were subjected to History, clinical examination and MRI LSS pre and postoperatively. Results: Untethering procedures were performed in 25 patients (age range, 3 months-26 years), 13 males and 12 females. The most common preoperative sign or symptom was pain (94%), followed by motor deficits (94%), sphincter affection (62.5%), and foot deformity (32%).The level of conus in the preoperative MRI was low lyingin 24 patients (96%).After detethering, pain was the most responsive to surgery with 86.7%improvement, followed by weakness (66.7%), then sphincters (50%). Foot deformity showed no spontaneous improvement but was stationary in 62.5% of cases, and still progressive in 37.5 % 0f cases. Conclusion: The surgical outcome was excellent for the resolution of pain and good for motor deficits, but disappointing for bladder dysfunction. So, Early diagnosis and adequate surgical release might be the keys to a successful outcome in school aged children, adolescents, and young adults with TCS.