Spinal cord perfusion may be compromised by the initial trauma, surgical manipulation, hematoma formation, and reductions in blood pressure and cardiac output. Similar to cerebral perfusion pressure, spinal cord perfusion pressure (SCPP) is determined by mean arterial pressure (MAP) and intraspinal pressure (ISP) (or central venous pressure [CVP] if CVP > ISP): SCPP = MAP − ISP. Blood vessel injury (decreased local blood flow), systemic hypotension (decreased MAP), and obstruction to blood flow (either segmental or elevated ISP) will decrease SCPP. Methods to maximize SCPP include elevating MAP to maximize perfusion, monitoring cerebrospinal fluid (CSF) pressure within the thecal sac, and CSF drainage to maximize perfusion pressure.