OBJECTIVE: To retrospectively analyze the clinical experience in the prevention and treatment of cerebrospinal fluid leakage complicated by posterior spinal surgery. METHODS: We reviewed 67 cases of posterior spinal surgery from July 2008 to June 2009 and 7 cases of cerebrospinal fluid leakage: 2 cases of dural injury due to trauma and 5 cases of dural injury due to medical origin of surgery. RESULTS: After surgical repair to strengthen the leak suture, placement of a tube for continuous drainage along with reasonable application of antibiotics and keeping the wound neat, all incisional leaks stopped in 7 to 14 d and all were cured. Conclusion: Intraoperative surgical repair, tight suturing of the incision, and placement of a tube for continuous drainage along with reasonable application of antibiotics and keeping the wound tidy are effective methods to prevent and treat cerebrospinal fluid leaks. In recent years, with the widespread development of spinal surgery, dural and arachnoid injuries also occur from time to time. Failure to detect and close the dural fissure in time leads to postoperative cerebrospinal fluid leakage, which not only affects the surgical outcome, but in severe cases can cause septic meningitis and even endanger the patient’s life. It is necessary to get timely and effective treatment to promote the healing of cerebrospinal fluid leakage. 1. Data and methods 1.1 General data A review of 67 cases of posterior spinal surgery from July 2008 to June 2009, with 7 cases of cerebrospinal fluid leakage. Causes of occurrence: trauma (dural injury due to vertebral fracture dislocation) in 2 cases, and dural injury due to surgical medical origin in 5 cases. Site of occurrence: 4 cases in the thoracic spine and 3 cases in the lumbar spine. 1.2 Diagnosis of cerebrospinal fluid leakage Obvious dural injury or cerebrospinal fluid leakage during surgery; postoperative wound dressing infiltration, the beginning of the exudate is red or light red, there is light red or clear exudate in the wound when the dressing is replaced, and the dressing is quickly infiltrated after replacing the wound dressing. 1.3 Clinical treatment methods Intraoperative treatment: we should treat the dural injury differently according to the specific situation. For smaller fissures that are difficult to detect, hemostatic gauze can be used for filling and blocking, tightly suturing the muscle, fascia, subcutaneous tissue and skin, and closed drainage of the epidural drain. For a large dural defect, direct suturing is often too tense and may cause a circular compression of the cauda equina or spinal cord. Postoperative treatment: (1) Reasonable lying position: Let the patient lie prone with the pillow removed, elevate the end of the bed, and keep the head low and feet high to prevent or reduce the continued leakage of cerebrospinal fluid, and also to avoid hypocranial pressure headache caused by the massive drainage of cerebrospinal fluid. (2) Local treatment: keep the incision dressing clean and dry, apply pressure dressing appropriately, and operate strictly aseptically. (3) Systemic treatment: routine anti-inflammatory treatment, use antibiotics with high concentration distribution in the cerebrospinal fluid to actively prevent infection; supplement a certain amount of saline to relieve hypocranial pressure; oral administration of acetazolamide and other drugs to reduce cerebrospinal fluid secretion (4) Strict observation and care: daily recording of drainage flow and replacement of drainage bags, observation of changes in the condition. The time of extubation is decided according to the amount of drainage flow, generally the drainage flow is less than 50ml for 2 consecutive days can be extubated, but must exclude factors such as drainage tube obstruction, the incision often has more exudate when the drainage tube is blocked, can be identified. For patients with more postoperative cerebrospinal fluid leakage, extubation time can be appropriately postponed to 7-14 days according to the patient’s condition, with the aim of waiting for the surgical incision to heal, and cerebrospinal fluid leakage can be stopped when the cerebrospinal fluid leakage channel is blocked after extubation (5) Longer duration of disease: attention should be paid to the prevention and treatment of electrolyte disorders. 2, the results of 4 cases by using intraoperative filling blocking hemostatic gauze or bioprotein gel cover, the incision healed in one phase. 3 cases by elevating the tail of the bed, the incision part of the moderate pressure, 10-14 days incision healing. In one case, mild headache, nausea and low cranial pressure symptoms occurred during drainage, which disappeared after rehydration, position adjustment and drainage control. In all cases, there was no infection in the incision and no mass formation in the incision. 3, discussion (1) injury to the dura formed after surgery cerebrospinal fluid leakage is a common complication of spinal surgery, dural injury involving the rupture of the arachnoid membrane, so that the central nervous system lost the dural barrier protection, closed cerebrospinal fluid circulation system with the outside world, easy to cause wound infection, serious intracranial infection, and even endanger the lives of patients. Clinicians should pay sufficient attention to the seriousness and danger of this complication and take active, reliable and prudent treatment to promote the closure of the wound and cerebrospinal fluid leak. The literature reports the incidence of dural injury in spinal surgery and the incidence of postoperative cerebrospinal fluid leakage to be 2.1%-9.37% [4-6]. The incidence of postoperative cerebrospinal fluid leakage in our group was 10.4%, which was analyzed as a result of intraoperative efforts to achieve complete decompression and pursue long-term results, in addition to trauma. (2) With the continuous development of spine surgery technology, high-risk and difficult spines are also increasingly carried out, and the incidence of injury to the hard mode is also on the increase. The causes of cerebrospinal fluid leakage in spine surgery are the following: fracture, injury to the dura mater after trauma; severe adhesions between the ossified posterior longitudinal ligament and the dura mater (individual dura mater is ossified); adhesions between the protruding disc or bone flab and the dura mater; medical factors, inexperience of the operator, lack of careful operation or underestimation of intraoperative difficulties. When performing spinal surgery, the occurrence of cerebrospinal fluid leakage should be effectively prevented: the degree of adhesions between the compressor and the dura should be fully evaluated before surgery; for those who need to perform resection of ossified ligamentum flavum, the necessary instruments should be prepared for the operation; good lighting should be ensured during the operation, and hemostasis should be thoroughly performed; the adhesions between the compressor and the dura should be carefully separated before resection of the compressor; when a local dural defect is found, care should be taken to protect the exposed arachnoid membrane; and the ossification of the ligamentum flavum should be performed if necessary. If necessary, floatation of the ossified ligament can be performed to achieve effective decompression without forcible excision. Careful operation can effectively avoid the occurrence of cerebrospinal fluid leakage and achieve good surgical results. (3) The dural defect and the presence of cerebrospinal fluid pressure are the main factors affecting healing: the blood supply to the dura comes from the segmental root artery, which has sent branches to the dura before entering the nerve root. Therefore, the dura has a rich blood supply and therefore has a strong ability to heal itself. The presence of a large dural defect and cerebrospinal fluid pressure are factors that affect dural healing, so intraoperative suturing is required in principle when a dural tear is found. When a large dural defect is found, in order to avoid circumferential pressure on the nerve caused by forced suturing, a fascial piece slightly larger than the area of the defect can be cut at the iliac bone and laid flat on the dural surface of the defect, and some operators have suggested that a lumbar dorsal fascia block can be cut and sutured to patch the defect and then covered with a sacrospinal muscle flap. This can provide a better soft tissue environment for local adhesions and accelerate the healing of the dura. Recently, some scholars also advocate the use of artificial dura mater to repair the defect. Cerebrospinal fluid pressure is also a factor affecting dural healing. The normal pressure of cerebrospinal fluid in the prone position is generally 70-180 mmH2O, and the local pressure of cerebrospinal fluid can be significantly reduced by taking the head high and foot low position, even to 0 or negative pressure, which is beneficial to the repair and adhesion of the dural defect. Therefore, patients with postoperative cerebrospinal fluid leak should maintain a head-high and low position to accelerate the healing of the dura.