Abstract: Objective To explore the surgical treatment of tethered cord syndrome and lipoma in adults and analyze its efficacy Methods One hundred and five adult patients with tethered spinal cord syndrome and lipoma who were admitted to department o neurosurgery of Chinese PLA General Hospital from February 2010 to September 2015 were included in this study. All patient had undergone microsurgical operation assisted with cavitron ultrasonic surgical aspirator (CUSA) under electrophysiologica monitoring. Surgical technology and experiences were introduced. With more than 3 months’ follow-up, the prognosis of patients with different symptoms was analyzed. Results All patients were followed up for 3 to 69 months (mean 29.92 months), and the outcomes were divided into five grades of recovery, improvement, stability, degradation, and newly occurrence. The results indicated that the surgical treatment was most effective to pain relief with an efficiency of 74.42%, followed by refractory ulcers of lower limb and perineum, bowel dysfuction, sensory abnormalities of limbs, muscle strength of extremity limbs and urinary dysfunction. No significant improvement was obtained after surgery in muscle atrophy and deformities of lower limbs, while the existing symptom maintained without deterioration. Comprehensive analysis confirmed that microsurgical treatment for adult lipoma tethered spina cord syndrome was still effective. Conclusion For patients of techered cord syndrome and lipmoma with symptoms of pain, skin ulcer and defecation disorder or aggravating trend in existing symptoms, surgical treatment is still of high value.