Postoperative Cauda Equina Syndrome Revealing a Delayed-Onset Dural Tear Following Lumbar Spine Surgery: A Case Report

Dural tears are a well-known complication of spinal surgery. While most occur intraoperatively and are promptly identified, some are overlooked or develop postoperatively. Delayed-onset dural tears are relatively rare but can result in significant neurological complications, including cauda equina syndrome (CES). We report the case of a 74-year-old woman who developed delayed-onset CES following lumbar decompression surgery. Postoperatively, the patient experienced saddle anesthesia and urinary retention. MRI revealed a hematoma compressing the cauda equina. Emergency reoperation revealed a longitudinal dural tear with herniation and incarceration of the cauda equina. The nerve roots were successfully reduced, and the dural defect was repaired. The patient showed partial neurological recovery postoperatively. In this case, intraoperative dural vulnerability, suction drainage, and increased intrathecal pressure due to straining likely contributed to delayed dural rupture and nerve root herniation. Awareness of this rare but serious complication is essential. MRI findings and clinical symptoms should prompt urgent reoperation if CES is suspected. This rare case of delayed-onset CES due to a dural tear after lumbar surgery was likely precipitated by straining-induced intrathecal pressure. The case underscores the importance of meticulous intraoperative dural inspection, cautious drainage management, and early recognition of postoperative neurological deterioration.