Schistosomiasis is one of the most prevalent tropical diseases in the world. Spinal cord neuroschistosomiasis is an uncommon complication mainly due to infestation by Schistosoma mansoni and may be caused by Schistosoma haematobium. Diagnosis depends on detection of anti-bilharzial antibodies and MRI of lumbar spine. The main treatment is medical. Surgery is an option for resistant cases. From January 2009 to January 2020, we reviewed patients with conus medullaris bilharziasis, who received different modalities of management. Clinical presentation, treatment plans, outcomes, and complications were reported. We studied 21 patients with conus bilharziasis. Males constituted 95.2 % and the age ranged from 8-12 years with a mean of 9.8 years. Low back pain and hypothesia were present in 100 % of patients while retention of urine in 95.2%. Examination of urine for S. haematobium ova was negative in 100 %, while stool examination for S. mansoni ova was positive in 4.8%. Mild to moderate expansion of the distal spinal cord and conus medullaris was seen in 100 % of MR images. After medical treatment; complete improvement was achieved in 71.4%, and partial improvement in 9.5%. Surgery was done in 19 % after failure of medical treatment and physiotherapy of whom, 4.8 % improved completely, 4.8 % improved partially while no improvement occurred in 9.5%. Conus lesions in endemic areas should trigger the possibility of Bilharziasis. Early diagnosis by MRI and positive anti-bilharzial antibodies is essential for management to avoid complications.