Background Data: Lumbosacral Rachipagus Parasiticus is an extremely rare condition. Separation of a parasitic twin that is attached at the lumbosacral spine in the neonates is even less frequent. In this case the spinal cord was herniated through a spina bifida into the parasite. Purpose: The aim of this report is to present a case of Rachipagus
Parasiticus in which surgical separation was successfully performed. Study Design: Case Report and review of the literature. Patients and Methods: The child was 28 days old. Computed tomography, magnetic resonance imaging of the whole spine focusing on the lumbosacral spine provided the information necessary to perform surgery. The duration of surgery was 150 minutes. The parasitic twin hadn't neural attachment with the myelomeningocele. The child received 120 CC of blood. After separation of the parasitic leg, the dura was repaired using autogenous graft. Skin and subcutaneous tissue were closed directly after application of a wound drain for 24 hours.  Results: The parasitic twin was successfully separated, and the patient was discharged from the hospital after 4 days, moving her lower limbs proximally with some weakness in both feet. Conclusion: Rachipagus parasitic twin is a rare form of conjoined twin with a favorable outcome.Detailed perioperative evaluation and management planning, as well as multidisciplinary microvascular approach, are integral to perform the best separation surgery. (2016ESJ096)