Delayed cerebrospinal fluid leak following lumbar interbody fusion caused by floating lamina: A case report

Delayed cerebrospinal fluid (CSF) leakage after lumbar interbody fusion are scarce. Known causes include severe spinal canal stenosis and iatrogenic factors. This case presents a unique etiology, highlighting the importance of timely management. Prediction and prevention of postoperative complications is crucial.

We report a 37-year-old woman had recurrent low back pain and radiating right lower extremity pain for 2 years, which had exacerbated over the past week. Imaging revealed mild L5 spondylolisthesis, a free fragment of the L5-S1 lumbar disc, bilateral L5 pars defects (spondylolysis), and floating L5 lamina. Treatment involved L5 right laminectomy and L5-S1 lumbar interbody fusion. On postoperative day 6, the patient developed headache and bulging at the incision site.

Combined with analysis of the aspirated fluid, magnetic resonance imaging indications and patient's symptoms, a diagnosis of delayed CSF leak was made.

Resection of the remaining and floating L5 left lamina and direct suturation were performed for dural tear repair followed by postoperative drainage tube placement.

The patient was discharged with successful recovery 2 weeks after the second surgery. Follow-up lumbar magnetic resonance imaging confirmed resolution of the CSF leak and satisfactory recovery.

In lumbar pathologies with unique anatomy like a floating lamina, vigilance for delayed CSF leak is crucial. Meticulous preoperative imaging review and adaptable surgical strategies beyond conventional approaches are essential for preventing recurrence.