The patient came to the clinic 26-February-2015 complaining of huge CSF pocket under the skin 10 days after performing discectomy L4-5 and L5-S1 25-January-2015 in UAE. He has attacks of headache and fainting when changing the position. It was drained twice, the last 18-February-2015.

On examination, the patient is not limping with no scoliotic stance with SLRS 75 degrees both sides with weak dorsiflexion left foot 4/5 and hypalgesia left L5 and S1 roots. When the patient was put in supine position with coughing, the pocket raised more more than 3 cm. A compressing dressing was applied.

The patient sent for investigations: MRI lumbar spine done 26-February-2015 showing huge CSF pocket communicating with the intradural space more than 12 mm diameter at L4-5 and L5-S1 levels. Dynamic studies performed ruling out instability. Lab investigations ruled out the presence of infection.

The previous wound refreshed. A huge amount of CSF came out. Hemilaminectomy L4 and L5 and upper edge of the sacrum left side. Foraminotomy L5 and S1 left side. The left L5 root is intact, but there is recurrence of the extrusion which was removed and further cleaning of L4-5 disc space was achieved. The left S1 root was damaged and torn. There are several torn points in the posterior wall of the dura and slipped nylon stitch 4 zero. The root was compressed by an extrusion for what discectomy of L5-S1 was performed. The tears in the posterior wall of the dura were repaired by 6 zero nylon and the torn root was also repaired. Still having oozing CSF. A layer of lyodura with Glubran was applied over the posterior wall of the defective dura. There is still a tiny leak fro the lower corner of the left S1 root. BioGlue was applied to that corner and to several places to achieve water-tight repair of the dural defects. The head of the patient was maximally elevated and Valsalva maneuver was applied. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot became normal.

The patient has a huge dural defects, that will not close by time, instead they will harm the brain. Surgical repair and water-tight closure is the best solution.

The MRI data were misleading exaggerating the dural defects. They were multiple and the main source was the damaged left S1 root and tiny points near the slipped stitch at the posterior dural wall.