Management of the child with myelomeningocele and kyphosis is an extreme challenge to the orthopedic surgeon and spine surgeon on many fronts. Delayed or observation treatment may result in loss of functional independence and self-esteem. Early surgical correction may result in loss of truncal height, intra-abdominal upward volume effect on the diaphragm, and loss of pulmonary capacity. Late surgical reconstruction may be associated with significant morbidity and mortality. Early surgical intervention with preservation of growth may prove safer and result in improved function and independence.