1.What are the types of spina bifida? Spina bifida is categorized into two main types: occult spina bifida and dominant spina bifida. 2.What is the difference in symptoms between occult spina bifida and dominant spina bifida? Can they be clearly distinguished by visual observation alone? In occult spina bifida, there is only a fissure of the vertebral plate, or the spinous processes of the vertebral plate are split at the same time, or the vertebral plate is missing extensively, and the spinous processes do not exist, but there is no outpouring of the contents of the spinal canal. In dominant spina bifida, due to incomplete closure of the vertebral plates, the contents of the spinal canal expand outward through the defect and form a cystic mass under the dorsal skin, i.e., spondylolisthesis or spondylodiscospondylolisthesis. In some cases, the spinal bulge protrudes into the thoracic, abdominal or pelvic cavity. In other cases of spina bifida combined with vertebral and intervertebral foraminal malformations, the spinal bulge may protrude laterally into the spinal canal. If the patient’s imaging (X-ray, CT, MRI) has confirmed spina bifida, and there is a prominent mass in the back, it is mostly dominant spina bifida; if there is no mass in the back, it is mostly occult spina bifida. 3. Is it necessary to treat occult spina bifida without symptoms? If a patient is confirmed to have occult spina bifida by imaging (X-ray, CT, MRI) but does not have clinical symptoms, surgery is usually not needed. However, if the patient has a combined spinal cord embolism and is under 18 years of age, most experts recommend spinal cord embolization. This is because once a patient develops symptoms, they are irreversible (surgery after symptoms develop is not effective). Many patients’ symptoms worsen after the age of 18 because the adhesions that cause spinal cord embolization can gradually worsen with age. 4. Can occult spina bifida develop into dominant spina bifida? It is difficult for occult spina bifida to develop into dominant spina bifida because of the well developed muscles in the lower back. 5. Is there no need to pay special attention to such patients? What should I pay special attention to in my daily life? Although occult spina bifida does not usually develop into dominant spina bifida, it does not mean that occult spina bifida does not need special attention. This is because occult spina bifida is often accompanied by developmental abnormalities of the spinal cord or nerves, such as localized scarring, adhesions, thickening of the terminal filaments, arachnoid cysts, or coexisting pathological conditions such as lipomas, epidermoid cysts, teratomas, spinal cavernosities of the spinal cord terminal, and cysts of the nerve root sleeves. And these pathologic conditions often cause spinal cord embolism or spinal cord compression. 6. What symptoms of occult spina bifida mean that the disease has worsened? What should be done at this point? If a patient with occult spina bifida develops symptoms such as lower limb weakness, numbness, muscle atrophy, enuresis, and dry stools, it often means that the disease has worsened. Further aggravation of the patient’s symptoms can also occur in clubfoot deformity, urinary incontinence, urinary retention, paralysis of the lower limbs, loss of sensation, coldness of the lower limbs, sacral ulceration. Individuals with spina bifida also have symptoms in the upper limbs. In principle, patients with spina bifida should be operated when they have minor symptoms to prevent further aggravation of symptoms. 7. What are the methods of treating occult spina bifida? What is the purpose of surgery? Anyone with spina bifida causing spinal cord embolism syndrome is suitable for surgery. And early surgery is advocated. Only when the spinal cord embolism is lifted by surgery can the chance of cure and improvement be achieved.