Symptomatic pneumocephalus is a rare complication of degenerative lumbar spine surgery. This is a case report of a patient who developed transient diplopia associated with pneumocephalus following lumbar spine surgery complicated by a dural tear. The diplopia improved as the pneumocephalus resolved. Factors involved in the development of pneumocephalus include an unintended durotomy and intraoperative reverse Trendelenburg positioning that was utilized to decrease the risk of postoperative vision loss. When encountering cerebrospinal fluid (CSF) leakage intraoperatively, spine surgeons should level the operating table until closure of the dural defect to prevent potential complications associated with pneumocephalus. If postoperative patients complain of severe headaches or display a focal cranial neurologic deficit, then a computed tomography (CT) scan of the brain should be ordered and evaluated. Consulting neurologists should be aware of the circumstances surrounding this rare complication. 1. Introduction Symptomatic pneumocephalus is a rare complication of degenerative lumbar spine surgery. This is a case report of a patient who developed transient diplopia associated with pneumocephalus following lumbar spine surgery, which then improved as the pneumocephalus resolved. Factors involved in the development of pneumocephalus included an unintended durotomy and reverse Trendelenburg positioning that was utilized to decrease the risk of postoperative vision loss. As spine surgeons increasingly position patients in this fashion, the risk of pneumocephalus associated with dural tears will correspondingly increase. Therefore, the recommendation is to level the operating table when a dural tear is encountered and to raise the head of bed only after satisfactorily closing the dural defect. Consulting neurologists for patients in the postoperative period may benefit from being aware of intraoperative reverse Trendelenburg positioning possibly contributing to the risk of pneumocephalus. 2. Case Presentation A 65-year-old male presented with a surgical history of an L2–4 posterior instrumented arthrodesis performed at a local hospital. Previous history included a vitreous humor hemorrhage in the left eye, resulting in slightly decreased vision in that eye. The patient is a former professional golfer. He was able to return to playing golf approximately six months after his previous surgery. Over the past year, he had a significant decline in his ability to ambulate due to recurrent low back pain radiating down both lower extremities, which was consistent with
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