Meningomyelocele is the most common disease of the spina bifida, and repair surgery is recommended within the first 48 hours of life to prevent infection and secondary neurological damage. The basic surgical approach is a five-layer closure that closes the five layers of the spinal cord, dura matter, fascia, subcutaneous tissue, and skin. Comprehending the relationship between normal anatomy of the spinal cord and myelomeningocele is key. In this section, we discuss the basic repair surgery of meningomyelocele by describing the surgery of lumbosacral meningomyelocele.