The severity of symptoms of spinal bulges varies depending on the type of bulge and the location of the lesion. The severity of spinal bulge is related to the type of bulging material In general, the spinal cord and spinal canal are, in order from inside to outside: the spinal cord is surrounded by a layer of soft spinal membrane (e.g., A in Figure 1), and the outer layer is the arachnoid membrane (e.g., B in Figure 1), which forms a cavity between the arachnoid membrane and the soft spinal membrane for the subarachnoid space (e.g., ① in Figure 1) containing cerebrospinal fluid; outside the arachnoid membrane is the dura mater (e.g., C in Figure 1), which forms a cavity between the arachnoid membrane and the The subdural cavity (② in Figure 1); the epidural cavity (③ in Figure 1) is formed between the dura mater and the anterior and posterior walls of the bony spinal canal. It can be seen that the relationship between the spinal cord and the spinal canal is like the cross-section of a large onion, with one layer wrapped around the other for a total of three membranous layers, with tiny lacunae between the layers to facilitate the relief of external pressure on the spinal cord and to promote the circulation of cerebrospinal fluid to maintain the normal function of the spinal cord. If only these spinal membranes bulge from the spinal fissure, and no spinal cord and other neural tissue bulge, then it is a simple spinal membrane bulge (Figure 2), which is relatively rare, the symptoms are generally not too serious, timely surgery to repair the spinal membrane can be; if the spinal membrane bulge at the same time, the spinal cord is also bulging, bending, then the spinal cord spinal membrane bulge (Figure 3), most patients belong to this type, the spinal cord at this time The function of the spinal cord is generally impaired. If the bulging spinal cord is retracted, adhesions are released, the spinal membrane is repaired, and the normal shape of the spinal cord is maintained, then the condition will not worsen, and with good functional exercise after surgery, the child can achieve normal defecation and walking. If the degree of spinal cord bulging is more serious, the whole spinal cord is bulging out, or even reflexed back from the fissure, then the patient’s symptoms are relatively serious (Figure 4), and the main purpose of surgery at this time is to prevent the disease from continuing to aggravate and restore the function of the spinal cord as much as possible, but the sequelae are relatively serious. Figure 1 Structure of the spinal cord and spinal canal (images from the internet) Figure 2 Simple spinal bulge Figure 3 Spinal cord bulge Figure 4 Severe spinal cord bulge (images from the internet) The severity of the spinal cord bulge is significantly related to the location of the spinal cord cone The severity of the patient’s symptoms is not only related to the type of bulge, but also to the location of the spinal cord bulge, which affects the height of the spinal cord cone. It must be dazzling to see so many unfamiliar terms, so let’s first look at why the location of the bulge affects the height of the spinal cord cone. The spinal cord ends in a lumbosacral bulge, which then tucks away to form the cauda equina, ending in a spinal cord cone that is connected to the sacrum by a segment of the terminal filament that contains no neural tissue (Figure 5). The spinal cord does not grow as fast as the spinal canal during the child’s growth and development, so the spinal cord will move upward relative to the spinal canal and, of course, the position of the spinal cord cone will also move upward. If the spinal cord bulges, the spinal cord in the lumbosacral region is squeezed by the spinal fissure on the one hand and pulled by the terminal filament on the other, which affects the normal rise of the spinal cord cone, thus forming what is known as a “spinal cord tether” on imaging. The lumbosacral segment of the spinal cord is responsible for urinary and fecal functions, as well as motor and sensory functions of the lower extremities, and when the spinal cord becomes embolized here, lower extremity dysfunction and urinary and fecal dysfunction may occur. If the spinal cord cone is too low, incontinence may also occur. If the spinal cord bulge is in the high cervicothoracic segment, most of them do not affect the normal upward movement of the spinal cord cone and can be repaired in time with less sequelae for the child. In general, spinal cord and spinal canal lipomas can also cause the spinal cord cone to fail to move upward normally. Therefore, some patients with spinal cord spondylolisthesis and spinal cord lipoma are often complicated by spinal cord embolism, resulting in weakness in urination and defecation, deformation of the lower extremities, and even claudication, which are collectively referred to as spinal cord embolism syndromes.