Spinal cord tethering due to a tense filum terminale may present with clinical features that include voiding dysfunction, back and leg pain, musculoskeletal and/or sensorimotor abnormalities of the distal legs and feet, and gait dysfunction. External dysraphic markers may be present over the midline lumbosacral spine, including skin dimples, hemangiomata, atretic tails or skin tags, superficial dermal sinus tracts, and/or bifid or Y-shaped gluteal folds. Magnetic resonance imaging (MRI) remains the most clinically useful and definitive diagnostic modality for tethered spinal cord and should be used to assess the filum terminale, position of the conus tip, and presence of syringomyelia. Spinal cord tethering may be successfully treated with transection of the filum terminale. Careful peri-operative assessment and follow-up of voiding dysfunction and syringomyelia will optimize long-term outcomes.