Like other lumbar spine surgeries, dural tear is a known complication of open midline decompression (OMD) and ligament reconstruction. It is mostly identified and repaired intraoperatively. Repair can be direct (suture repair) (preferred method) or indirect (fat/muscle graft, artificial dura, collagen matrix, gelatin sponge, fibrin, fibrin glue, polyethylene glycol). In case of large dural defect where suture repair alone is insufficient for closure, we prefer using artificial dura as inlay graft and securing it to the dura with sutures leading to a watertight closure. Revision surgery may be required in cases with symptomatic delayed presentation due to CSF leak or pseudomeningocele formation. Scar tissue formation is less after ligament reconstruction compared to conventional decompression enabling an easier dissection in revision surgery. Horizontal ligament is removed, which gives access to the spinal canal. Dural defect is identified and repaired. After dural repair, horizontal ligament is reattached to maintain ligament reconstruction.