The patient came to the clinic 06-July-2019 complaining of LBP with bilateral sciatica symmetrical with numbness big toes both feet after performing the third surgery for PLD L5-S1 elsewhere. MRI after the last surgery performed 05-April-2019 showing CSF pocket at the site of surgery with bulge disci L4-5 and L5-S1.

On examination: She is in agonizing pain, limping and no scoliotic stance. SLRS was 40 degrees both sides without pain. There was weak dorsiflexion right foot -4/5, left foot 3/5 and with analgesia left L5,S1-2-3.

The patient was sent for investigations: MRI lumbar spine performed 06-July-2019 showed enlargement of the CSF pocket. Dynamic studies ruled out overmobility. Lab investigations were uneventful. Ct-scan showed normal facets.

The wound was opened and exploration of the CSF pocket and its relation with the dura was inspected. There were several pints at the left upper corner , through which CSF leaf was taking place. Some of the visually seen points were stitched by 6 zero nylon. Using Glu-Bran with muscles and fat aided to the defective area were applied. The patient was put in head up position with Valsalva maneuver and hyperventilation ruled out presence of CSF leak. Water-tight closure of the wound.

Smooth postoperative recovery. The power planterflexion of both feet normalized. He was sent to the ward.

The Persisting CSF pocket was causing a harm to the patient  and surgery was mandatory to prevent trauma to the brain and all neural structures. After closure of the defects. the patient regained full power of the feet.