Postoperative dural tear and cerebrospinal fluid (CSF) leakage are among the most common complications in spinal surgery. Disruption of dural integrity allows CSF to escape into epidural or subcutaneous tissues, resulting in pseudomeningocele, wound infection, meningitis, and nerve root irritation. Intraoperatively recognized dural tears are routinely repaired using primary sutures, patch grafts, or fibrin sealants, while unrecognized or recurrent CSF leaks remain a significant clinical challenge. This chapter provides a detailed discussion of the pathophysiology, risk factors, diagnostic strategies, and current evidence-based treatment protocols for CSF leaks after spinal surgery. Early recognition, meticulous surgical repair, and comprehensive postoperative management significantly reduce infection and neurological morbidity.