Occult spina bifida often involves the lumbar and sacral vertebrae, and may present with pigmentation, capillary hemangioma, localized hirsutism, etc. Observation can be chosen for mild lesions, and surgical excision of lesions is often chosen under microscope and evoked potential electrical stimulation in cases that require treatment. Specific cases are as follows: 1) cryptogenic spina bifida is often combined with spinal cord embolism and thickening of the end filaments, which can be cured by opening the spinal canal under the microscope and evoked potentials, disconnecting the end filaments, and moving the spinal cord upward gradually; 2) cryptogenic spina bifida is often combined with longitudinal fissure of the spinal cord, which needs to be closely protected by microscope from the middle of the spinal cord and the nerve roots on both sides of the lesion and resected; 3) dermatomal cysts are found in the spinal cord or around the nerve roots. If there is a dermatocyst in the spinal cord or around the nerve roots, it needs to be completely separated from the nerve roots or spinal cord together with the peripheral membrane under the microscope, and the cure rate reaches more than 95%; 4. Occult spina bifida combined with intravertebral lipomas needs to be dealt with in accordance with the relationship between the fat and spinal cord.