Spina bifida occurs at about 28 days of gestation, mostly in the lumbar and cervical regions, and is a serious and clinically important congenital spinal cord malformation in newborns. Spina bifida, which occurs at 28 days of gestation or earlier, has a spinal cord deformity mostly located between the thoracolumbar region with an exposed central canal, and is still clinically referred to as a spinal bulge. Spinal cord spondylolisthesis can occur in any area of the entire spine from the posterior cervical region to the lumbosacral region, and can be complicated by hydrocephalus in 65% of patients. Spinal cord spondylolisthesis in the lumbosacral region is often combined with spinal cord tethering, which in turn affects lower limb movement and continence. For spinal cord spinal cord bulge first preoperative evaluation: including size, location, bulging bursa contents of the spinal cord or cauda equina how much, adhesions, the patient’s current functional impairment, the presence of bursal rupture, the presence of infection, combined hydrocephalus, etc.. 1, medical history, ask whether a soft mass was found after birth in the lumbosacral region, the back of the neck or the midline of the back, whether the mass gradually increased in size and tension when crying, whether there are deformities of the lower limbs and urinary and fecal incontinence, whether there is cranial enlargement and mental retardation, seizures, etc. 2.Neurological examination, whether there is motor disorder and deformation of both lower limbs, whether there is incontinence of urine and stool, whether there is saddle-shaped sensory disorder in perineum. 3.Local examination, pay attention to the size of the mass and the width of the base, the presence of spinal cord and cauda equina nerve shadow during fluoroscopy, whether the surface skin is normal or translucent membrane, and whether there is ulcer or perforation leakage. 4.X-ray plain radiograph of the spine to understand the site and extent of vertebral defects. 5.X-ray plain film examination, which can show the extent and scope of the developmental defect of vertebral canal bone. 6, MRI examination, which can show the spinal cord and nerve roots within the capsule and reveal other deformities that are often associated, such as spinal cord embolism, intradural (or (and) subcutaneous) lipoma, dermatomal cyst or epidermoid cyst, etc. The main complications of spinal bulge are cerebrospinal fluid leakage and consequent cerebrospinal meningitis; and secondary spinal cord embolism, such as incontinence and impaired motor function of the lower extremities and sensory disturbances in the saddle area. Treatment Anyone with mild neurological symptoms and no hydrocephalus should be treated early with spina bifida repair surgery. Children with spina bifida combined with spinal cord tethering are usually asymptomatic as children, but as the body develops, the tethered spinal cord is stretched and symptoms appear, so spinal cord tethering should be released as early as possible. 1. Studies have shown that once motor dysfunction occurs, such as weakness and numbness of the limbs, only about 45% of patients recover normally; once urinary incontinence occurs, only 12% of patients recover normally, and if incontinence still occurs, the artificial body nerve-visceral nerve reflex arc surgery is available. Therefore, once spinal cord tethering is detected, it should be treated surgically regardless of the presence or absence of symptoms. Families recognize at birth that the posterior back masses, vascular nevi, skin depressions and hypertrichosis are not the surface of the phenomenon and that there may be congenital malformations of the spine and spinal cord in the spinal canal. They should be examined early and operated on nearly as early as possible, and should not be operated on hastily after the onset of obvious symptoms, which may lead to lifelong regret. With the major advances in modern anesthesia and neurocritical care, the patient’s age is currently not a major issue limiting surgery. 2. Severe paralysis of both lower limbs and those with hydrocephalus should be considered as contraindications to surgery. 3.The period of surgery is usually performed in the postnatal period from 3 to 6 months. If the cyst wall is thin and will rupture or has ruptured, surgery should be performed as early as possible. For those who have formed local ulcers, the dressing should be changed until 3 to 5 months after the wound is healed before surgery. 4. Surgical methods and points to note: (1) Use prone position with head down and feet up. (2) Generally use transverse incision. (3) The skin should not be excised too much to prevent the skin from being too tight during suturing. (4) The cystic neck should be free to the bone defect, and the laminae and epidural scar adhesions should be excised if necessary. The nerve tissue should be thoroughly loosened and freed, and the functional cauda equina should be preserved as much as possible, but the end filaments causing traction to the cone should be cut. 5, the bone defect should be repaired by applying the capsule wall or lumbar dorsal fascia for reinforcement, and tight suture to prevent fluid leakage.