The patient was operated for lumbar canal stenosis L4-5, for what decompressive laminectomy L4, L5 with transpedicular fixation L4-5 was done 2 weeks ago in Azerbaijan. The patient the next 3 days progressed CSF leak from the wound and persisted with huge amount of leak making him complaining of headache and unable to walk.

On examination, the patient in wheelchair. There is weak dorsiflexion both feet 4/5. CT-scan showing as be the screws in acceptable position, but the upper left screw is directed more medially. MRI done 23-October-2016 showing wide defect full of CSF leak with pocket reaching the skin with CSF amount around 200 ml. It seems that the CSF leak is coming more from the left side.

The old wound refreshed. A huge amount of CSF came out immediately after skin opening. Inspection of the wound: the dura is torn in several places mainly in the middle and at the left side. The screws are acceptable. It seems that they are Turkish production. Further drilling of the bone to reach the healthy dura and find the healthy edges of the dural tears. The dural tears were repaired using 6 zero nylon. There was a material resembling surgicele which was pushed to the left upper most corner. It was removed. After tedious repair of the dural defects, the patient was put in Valsalva maneuver and no CSF leak was noted. Over the dura, a piece of Lyodura adapted to the area was put over the dura and Glubran was used to obtain solid closure of the dural area. Cross connector was applied to the construct. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet improved and he was sciatica free. He was sent to the ward.

The patient has persistent CSF leak with huge amount, which necessitate exploration.

In case that the CSF is coming 100 ml/h. This means that the dural defect is large as in this case and repair is mandatory as soon as possible.