Spinal cord bulge is a congenital developmental malformation in which the spinal cord and nerve roots bulge out from the bony fracture due to incomplete fusion of the vertebral plates caused by an embryonic disorder of neural tube closure, often accompanied by localized abnormal fatty growth, also known as fatty spinal cord bulge. The clinical symptoms include varying degrees of bilateral lower limb weakness and urinary and fecal dysfunction. Untreated or inappropriate surgical procedures can seriously affect the quality of life of the child. Earlier, the diagnosis of spinal cord spondylolisthesis with localized lipoma was unclear because there was no support from imaging technology. The authors summarize 18 cases of spinal cord spondylolisthesis in children admitted to our hospital from 2007.1 to 2008.5, of which 8 cases were accompanied by lipoma. One child developed hyperthermia and local cerebrospinal fluid leakage after surgery, which healed after 1 month of debridement and drug exchange, and the rest healed in one stage. The prognosis was good for 5 children with normal development, and their families were reluctant to review MRI. Discussion: Spinal cord spondylolisthesis is a relatively common congenital disease in children, with an incidence of 1-5/1000, occurring mostly in the lumbosacral region, and often combined with severe intraspinal deformities, including intraspinal Fatty deposits, fatty changes in the spinal cord and conus, as well as fatty, fibrous connective tissue and conus or cauda equina nerve wrapping mixed growth and adhesions with the dura, causing strain on the spinal cord, thus affecting the lower limbs and urinary and fecal functions of the child, seriously affecting the quality of life of the child. The child often has neurological deficits or transection paraplegia. In sacral spinal cord spondylolisthesis, there is flaccid incontinence, foot entropion, ptosis or high arched foot deformity; lumbar spinal cord spondylolisthesis may show bilateral lower limb paralysis, neurogenic bladder, and fecal blockage in the abdomen can be palpated. The diagnosis of spinal cord spondylolisthesis relies on typical symptoms: cysts are mostly located in the midline of the back, covered with normal skin, positive transillumination test when the skin is very thin, visible inside the cauda equina and other nerve tissue. In combination with lipoma, the subcutaneous tissue is thickened, lobulated and soft. There may be local hair growth, pigmentation and other abnormal manifestations. There is an impulsive sensation in fontanelle when the cyst is compressed. The degree of spinal cord damage is determined by the following tests: motor and sensory impairment of the lower extremities; the presence of fecal incontinence and urinary disturbance, filling of the bladder; relaxation and ectropion of the anal mucosa; and the strength of contraction of the anal sphincter. The symptoms are not easily detectable in infants and children. Imaging can be an important basis for diagnosis and understanding the localization of the lesion: X-rays mostly show spinal deficiency of the vertebral plate, widening of the spacing between the vertebral arches, and bony defect sites connected with soft tissue masses. MRI has an important diagnostic value for spinal cord spondylolisthesis and should be the first choice. MRI can clearly show the location and morphology of the spinal cord, the thickened end filaments, the morphology and contents of the dural sac, and can detect all tethering and almost always find the cause, providing an important basis for the development of surgical plans. If there is a low cone of the spinal cord, below the L3 level, thickened end filaments, or the spinal cord is fixed by a lipoma or other deformity, then tethering is clearly indicated. In the presence of a lipoma, long T1 and long T2 signals can be seen, which can be suppressed in the fat suppression sequence, because the lipoma causes compression of the spinal cord or cauda equina and exacerbates the corresponding symptoms, so it is important to understand the location of the lipoma in relation to the spinal cord cone. In the paracone type, the fat encroaches on one side of the conus and wraps around the cauda equina on one side; in the supracone type, the fat encroaches on the supracone part of the spinal cord and can pull the spinal cord into an angle dorsally. MRI of all eight cases showed spinal cord bulging in the capsule or low fixation, and localized adipose tissue signal. The disease needs to be differentiated from the following cases: 1) simple spinal bulge and spinal cord spinal bulge: because the appearance of the three is similar, but the surgical approach and prognosis are different, preoperative MRI images need to be carefully distinguished, if available intraoperative nerve stimulation measurement and histological examination should be done to identify, as far as possible to remove the lipoma and preserve the nerve tissue. 2) teratoma: sacrococcygeal teratoma is low in position, varying in size, shape They are irregular in size, uneven in hardness, mostly cystic in nature, and are mostly located to one side. However, there are often substantial pathological tissues, such as bones, teeth, cartilage and so on. It is well defined and has a negative transillumination test. There is no traffic with the subdural cavity, and there is no impulse of fontanelle when compressing the cyst. x-ray shows that there is no defect in sacrum. 3) Lipoma: subcutaneous lipoma is soft, lobulated, with clear boundary, and there is no cerebrospinal fluid on puncture. However, the spinal cord is often combined with a subcutaneous lipoma in this area. 4) Dermatomal cyst: The wall of the cyst is composed of connective tissue and contains sebaceous glands, sweat glands, hair and so on. There is still shed epithelium and sebum inside the cyst, and the overlying skin is normal. The cysts are small, closely attached to the skin, movable and slightly parenchymal. The transillumination test is negative, there is no traffic with the vertebral canal, and there is no impulsive sensation of fontanelle when compressed. Preoperative MRI can help identify the above lesions, and pathological examination of the resected material can clarify the diagnosis. Contraindications to surgery include: (1) a large thoracolumbar spinal cord bulge with severe lower limb paralysis; (2) a combination of severe hydrocephalus with obvious mental retardation; (3) other severe deformities, such as scoliosis, retrognathism, etc.; (4) severe brain injury at birth, intracranial hemorrhage, microcephaly, and cerebral hypoplasia.