Objective and background: Tethered cord syndrome (TCS) in adults is rarely diagnosed as well as it is a complex clinicopathological entity that remains poorly understood. In this study, clinical outcomes of 23 consecutive congenital TCSs diagnosed in adults have been evaluated to establish a standard approach to treat congenital TCS diagnosed in adults. Methods: Medical records were retrospectively reviewed in 73 cases of tethered cord syndrome whom underwent surgery in our hospital, between the years 2005 and 2014. Cases which diagnosed and treated surgically in adults (patient age> 18 years) were included in this study. Results: Twenty-three cases of TCSs were treated surgically in fifteen female and eight male patients. The mean age was 30.3±10.7 years. The mean follow-up period was 75.6±40.5 months. The most common complaint was low back pain. The most common findings in the neurological examinations were muscular weakness and urinary incontinence. The most common co-malformations were diastematomyelia and vertebral fusion anomalies. The most common terminated level of filum terminale was L5 level. Detethering carried out in 87% of patients and bony septum resection without detethering applied in 13%. Laminaplasty was achieved only in 39.1%. 60.9% of patients are recovered good. 34.8% of patients are improved. The most common complication was CSF leakage. Conclusion: Despite the good results obtained in our surgical interventions for symptomatic TCS in adults, tethered cord releasing is complicate procedure and has serious complications. Therefore, the authors suggest planning surgery according to symptoms emphasized with full neurological examination, craniospinal MRI and urodynamic test.