Navigating Post-operative Complications: A Case Report of Cerebrospinal Fluid Leak and Pan-Resistant Enterobacter Infection Following Lumbar Fusion

Introduction: Post-operative cerebrospinal fluid leakage and deep surgical site infection are challenging complications after instrumented lumbar fusion, and their coexistence – especially with multidrug-resistant organisms – increases morbidity while jeopardizing neural integrity and implant stability. Case Report: A 65-year-old woman with diabetes mellitus and hypertension developed persistent wound discharge 1 month after L4–L5 decompression and fusion, with cultures revealing pan-resistant Enterobacter infection. Despite serial debridements and empirical antibiotics, she developed a refractory cerebrospinal fluid leak due to occult dural-tear confirmed intraoperatively with fluorescein localization. Management included repeated meticulous debridement, targeted intravenous and intrathecal colistin therapy, and temporary thecoperitoneal shunting for cerebrospinal-fluid diversion, followed by definitive dural repair with shunt removal that achieved complete infection control and leak resolution. At 2-year follow-up, she was asymptomatic with stable fusion and no recurrence. Conclusion: Early recognition of deep infection and prompt multidisciplinary intervention are essential to prevent catastrophic sequelae after instrumented lumbar fusion. Tailored antimicrobial therapy, cerebrospinal fluid diversion, and staged surgical repair can clear infection and achieve durable dural healing while preserving spinal instrumentation. Keywords: Cerebrospinal fluid leak, pan-resistant Enterobacter, spinal surgical site infection, lumbar fusion, multidisciplinary management.