In the last decade there have been significant improvements in all the fields of management of patients with spinal dysraphism, which have increased dramatically the quality of life of these children. Prevention of spina bifida with food fortification is becoming increasingly practiced worldwide. As result, in many parts of the world the frequency of myelomeningocele has decreased. Intrauterine closure of myelomeningocele has been attempted in many institutions with variable results. While it is still at the sphere of experimental therapy, it is reasonable to anticipate progress in this field in the next decade. Antenatal MR imaging is already providing very high level of detail even before the child is born. This creates new ethical dilemmas and requires additional care, but has improved significantly the overall management of patients and their families. Further improvements are anticipated in this field. Management of neuropathic bladder has improved significantly in the last decade and is anticipated to play an increasing role in the long term follow up. Surgery for spinal cord tethering in all its forms has improved in the last decade, with far more chances of complete untethering now in comparison to 10-15 years ago, with the use of micro-neurosurgical techniques and intraoperative monitoring. It is reasonable to expect that in the next decade, intraoperative neurophysiological monitoring during spinal cord surgery will become mandatory. In the 2013 Annual Special Issue we have assembled a team of authors distinguished in their fields, who bring us up to date with all the latest developments.