Delayed Cerebrospinal Fluid Leakage With Central Nervous System Infection Following Posterior Cervical Laminectomy: A Case Report and Review of Literature.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To report a rare case of delayed cerebrospinal fluid leakage complicated by central nervous system infection following posterior cervical laminectomy, and to elucidate the associated diagnostic and management challenges. BACKGROUND: Acute cerebrospinal fluid (CSF) leakage is a recognized complication of posterior cervical spine surgery, whereas delayed CSF leakage remains exceedingly rare. When delayed CSF leakage coincides with central nervous system infection, delayed diagnosis may lead to catastrophic outcomes. We describe an unusual case of this complication following a cervical laminectomy. METHODS: A 60-year-old male underwent a posterior cervical C3-5 laminectomy and decompression with lateral mass screw-rod fixation for traumatic cervical spinal cord injury and multilevel cervical spinal stenosis. Postoperatively, he developed fever, cervicodorsal pain, and headache. The diagnostic workup consisted of magnetic resonance imaging, cerebrospinal fluid analysis, and microbial culture. RESULTS: Magnetic resonance imaging revealed a fluid collection at the surgical site, and cerebrospinal fluid analysis confirmed bacterial meningitis caused by Enterobacter aerogenes. The patient achieved complete neurological recovery following combined antimicrobial therapy and lumbar cistern drainage. CONCLUSION: This case highlights that nonspecific symptoms such as orthostatic headache and fever, emerging more than 48 hours postoperatively-even in the absence of an intraoperative dural tear-should raise suspicion for delayed cerebrospinal fluid (CSF) leakage with central nervous system infection. Definitive diagnosis requires prompt magnetic resonance imaging and CSF analysis. Early intervention with targeted antibiotics and lumbar cistern drainage is essential for optimal outcomes.