The patient a Yemeni citizen was operated by me 10-August-2002 for PLD L5-S1.She traveled to Yemen and 3 weeks ago started to feel pocket of collection at the site of the operation. She came to the clinic 29-Ictiber-2002 and CSF pocket was identified and she was admitted.

The wound was opened and a gush of CSF came out from multilobulated cavities with organized capsule. The dissection carried out until the dura was seen. There is a dural defect about 3 mm at the anterior border of the right S1 axilla. Nylon stitches were applied and water-tight closure of the defect was achieved.  The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. The multilobulated capsule was dissected off and removed to prevent possible inflammatory reaction after surgery. Routine closure of the wound.

Smooth postoperative recovery. She was sent to the ward.

The patient came to the clinic 03-November -2002 with clean wound and came 6 days later with the same clean wound

The patient then came 07-February-2007 complaining of right hip pain and signs right CTS. She was sent for investigations, but she disappeared.

There is still an estimated postoperative recurrence around 7%.

In retrospective analysis, why CSF leak was from this point (the anterior surface of the right S1 axilla), remain unknown. Mechanical traction could cause defect in the lateral wall of the root. Defect in the mid-posterior part of the dura could be explained by very thin dura at this location. A lot of cases when we predict an eminent CSF tear of defect, we apply dural repair or just bipolar coagulation to this point to prevent postoperative CSF leak.