BACKGROUND CONTEXT: Accidental durotomy causing CSF leak is a common complication of spine surgery.Up to now, the optimal treatment method remains unproven.Current core treatment concept has been focused on direct suture of durotomy, but it cannot avoid leakage from needle holes to outside of the wound.And in many cases, direct suture will prolong operative time and increase surgical risk.Surprisingly few published studies aim at increasing surgical wound resistance to pressure so as to indirectly prevent CSF leak.PURPOSE: For a further research and discussion about the new treatment strategy of CSF leak without direct suture repair of the durotomy and inquire the best time period of maintaining drain without suction in the subfascial space.STUDY DESIGN: Retrospective cohort study.PATIENT SAMPLE: Two hundred thirty four patients with accidental durotomy causing CSF leak during posterior spine surgery from 2005 to 2012 at our two institutions.METHODS: All cases were divided into 4 groups according to suture fashion of the deep fascia layer and days of subfascial drain without suction.For Group A, the choice of suture was an interrupted technique and drain was remained until output below 50ml/day when the incision healing was felt to yield enough resistance to pressure.Those cases with a running locked suture fashion were classified to Group B if the drainage tube was discontinued within 3 to 4 days postoperatively, Group C within 5 to 7 days and Group D within 8 to 12days.OUTCOME MEASURES: CSF leak through the wound and attendant complications; Mean time for incision healing.RESULTS: For Group A, there were 35.3% patients developing CSF leak through the wound (CSFLW) and 29.4% cases were cured with reoperation.Mean wound healing time (MHT) was 17.2±3.7days.There were 2 cases of superficial infection and 1 case of deep infection but cured finally.For Group B, there were 14.5% patients developing CSFLW but cured with reoperation.MHT was 11.3±2.9 days.In Group C and D, none was found with CSFLW and MHT was 10.4±2.5 days and 10.8±2.6 days respectively.The differences of MHT between Group A and Group B and comparing Group B to Group C and D were all statistically significant.CONCLUSIONS: CSF leak from the durotomy site could be indirectly prevented by way of tight suture of the deep fascia in a running locked fashion and placement of drain without suction in the subfascial space for at least 5 days.It was an effective and economic technique in managing CSF leak without suture of durotomy site.