Objective To explore the therapeutic effect of homogeneous spinal-shortening axial decompression (HSAD) in patients with tethered cord syndrome (TCS) and scoliosis. Methods Six patients with TCS and scoliosis, who underwent HSAD in Orthopaedics Department of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Apr. 2015 to Jan. 2018, were retrospectively included. The operation time, intraoperative blood loss and complications were recorded. Urodynamic examination was performed to evaluate the bladder function before and after surgery, including detrusor reflex, sphincter function, functional bladder capacity and maximal urination speed. Results There were three males and three females, aged 7-23 (mean 15.7±6.9) years old, with an average follow-up of (28±9) months. Five patients had incontinence, three had foot-drop, four had decreased lower limb muscle strength, one had low back pain, and one had congenital dislocation of the hip. The operation time was 180-320 min (mean[261±63]min), and the intraoperative blood loss was 650-1 100 mL (mean[925±167]mL). After surgery, the low back pain was completely relieved in one patient, and the muscle strengths of the lower extremities were improved in four patients. Five patients received urodynamic examination before and after surgery. Before surgery, four cases were evaluated as external sphincter overactivity and one case as uncoordinated sphincter activity; after surgery, two cases were evaluated as normal external sphincter activity, one case as coordinated external sphincter activity, and two cases as external sphincter overactivity. The functional bladder capacity of the five patients was 195.0 (127.5, 233.5) mL and 213.0 (188.5, 251.5) mL before and after surgery, respectively, and the difference was not significant (Z=-0.4, P=0.70). The maximal urination speed and residual urine before surgery were 7.3 (1.4, 10.3) mL/s and 130 (106, 200) mL, respectively, and were significantly different from those after surgery (10.3[5.6, 16.2]mL/s and 30[6, 174]mL, respectively; both Z=-2.0, both P=0.04). In the five patients, the bladder detrusor muscle strength was improved to different extents, the maximal urination speed was increased, and the residual urine was reduced. Conclusion HSAD is an effective one-stage technique to relieve the TCS combined with scoliosis, and it can effectively relieve the axial tension of the spinal cord, correct the deformity of the spine and improve the coordination between spine and spinal cord. The lower limb symptoms and bladder function are improved after surgery, and complications such as cerebrospinal fluid leakage, bleeding, and deterioration of neurological function are avoided.