206 patients with spina bifida were followed up during the last 20 years; they were examined from the pediatric, neurosurgical, urological and orthopedic point of view. Evaluation of the intellectual development was also performed. Most of the 92 children of the first group were born after Lorber in 1971 proposed a selective policy of treatment of newborn infants, 144 (group 2) prior to this time. Shunting devices to alleviate hydrocephalus were necessary in two thirds of all patients. The incidence of shunt obstruction most commonly of the ventricular end was very high during the first two years of age but decreased sharply thereafter. Radiological screening disclosed pathological changes of the upper urinary tract in more than one fourth of all children, especially in girls. In the older group 28% of the patients over 5 years of age were mainly bound to a wheelchair, as opposed to 14% in the younger group. Epileptic seizures occurred in 27 cases. Children with thorakolumbar lesions proved to have a poorer intellectual development than those with lumbosacral lesions. Low IQs (less than 90) were also evaluated in every second patient with a shunt dependent hydrocephalus. Since the adoption of selective treatment the percentage of patients with severe handicap has decreased significantly.