ABSTRACT
A cerebrospinal fluid (CSF) leak is a relatively rare postoperative complication following spinal surgery. A CSF leak can result in significant morbidity and possible mortality if untreated. A CSF leak is most commonly encountered following incidental durotomy during either anterior or posterior spinal surgery. Although most incidental durotomies are repaired intraoperatively without significant postoperative morbidity, persistence of spinal fluid leaks may lead to pseudomeningocele formation, arachnoiditis, intracranial hypotension, neural element herniation, wound dehiscence, fistula formation, and infection. Most cases of postoperative CSF leak can be managed via nonoperative methods. Initial management of CSF leak includes laying the patient flat to more evenly distribute CSF pressure. If positioning alone does not relieve or improve the leak within 24 hours, other non-operative interventions are warranted. There is no grading system for CSF leaks. Rather, CSF leaks are categorized based on their timing of presentation.
