Male, 8 months old, at birth, there was a swelling on the back of the chest, about 7.0×2.0×1.0cm3 in size, with an uneven surface and often bloody exudate, the swelling increased rapidly when the child was 6 months old. The child’s growth and development were normal, the scalp veins were not angry, the fontanelle was full and not closed, the cranial suture was not significantly widened, and the cranial nerve examination did not show any significant abnormalities. There was a swelling on the back of the chest (T2-4) with a size of about 14.0×8.0×8.0cm3. The limbs moved freely, and the pathological reflexes of both lower limbs were not elicited. The head CT and MRI showed obstructive hydrocephalus with a submicrocephalic tonsillar herniation malformation (type II), and the spinal cord MRI showed a spinal membrane bulge at the level of the thoracic 3 cone. The swelling was treated with general anesthesia in the right lateral position, a pike incision was made at the root of the swelling, the neck of the swelling was separated, and the neck of the cyst was about 1.5 cm in diameter. The child was discharged from the hospital 9 days after surgery. The cause of spinal bulge is unknown, but recent studies have shown that defects in the PAX-3 gene in mice (the human counterpart is Hup 2) can cause (spinal) bulge and Chiari II malformation [1]. In a spinal bulge, the lesion has a cystic bulge with cerebrospinal fluid inside the capsule and no neurological tissue or only a thin fibrous band attached to the spinal cord surface, usually without neurological symptoms. If the overlying skin of the bulge breaks down or becomes infected, it can easily cause cerebrospinal fluid leakage and cause meningitis, which can have serious consequences if not treated properly. This article discusses the timing of surgery and surgical methods for spinal bulge only. 1, on the timing of surgery Microsurgery for spinal bulge is more effective, but the timing of surgery is an important factor affecting the prognosis. Cui Ziqiang [2] statistical results of 56 cases of surgery were found to be cured within 1 month after birth, and the disability rate of those operated on after 1 year reached 18%. Ye Yuhu [3] believed that surgery for simple spinal bulge should be performed within 1-2 weeks after birth; if the skin is intact without rupture and the bulge is not significantly enlarged, it is safer to postpone surgery until 2-3 months after birth; if the wall of the capsule is thin or ruptured and there is potential infection, early surgery should be performed; if the infection has ruptured or there is cerebrospinal fluid leakage, the infection should be actively controlled and the trauma should be cleaned or healed before surgery. 4] believed that surgery should be performed in most cases after the newborn leaves the hospital infant room. There are recent case reports of in utero diagnosis of (spinal) spondylolisthesis by fetal ultrasound and ultrasound MRI, with surgery the day after birth [5]. In this patient, the spinal bulge increased rapidly after 6 months due to the lack of surgical treatment at an early stage, resulting in skin breakdown and infection, which increased the risk of surgery. 2. Surgical approach: The child is placed in prone or lateral head-down position with general anesthesia or basic anesthesia plus local anesthesia. If there is nerve tissue within the capsule, it should be carefully separated and returned to the spinal canal. It is often necessary to remove one or two segments of the lamina to adequately expose the spinal cord and separate it from the embolic fibroglial tissue. The dura mater is closed longitudinally with absorbable sutures and the lining is exfoliated to avoid involvement of extra-dural tissues such as fat, which can lead to diseases such as epithelioid cysts. The reconstructed dural sac should have sufficient internal diameter to avoid compression of the spinal cord. After the repair of the capsule neck, the jugular vein or anterior chimney is compressed to increase the intracranial pressure, and if there is a cerebrospinal fluid leak, the leak should be repaired and closed using paravertebral periosteum, fascia, or muscle pieces, or using overlapping sutures of the residual capsule wall, depending on the situation [4, 6, 7].