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Spinal durotomy, whether incidental or intentional, requires a watertight closure to prevent potentially significant complications. As a result of relatively recent technological advancements and research, spine surgeons now have many options for both intra-operative dural repair as well as managing post-operative cerebrospinal fluid (CSF) leak. This review presents a comprehensive overview of the current and historical treatment strategies in the management of spinal durotomy. Intra-operative treatment of intentional and incidental durotomies through a variety of available dural sutures, dural sealants and other patches and grafts as well as post-operative CSF leak management strategies including conservative measures, epidural blood patches, CSF diversion therapies and definitive surgical repair will be presented.