Spinal cord perfusion may be compromised by the trauma itself, surgical manipulation, and hemodynamic changes. 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 if it is greater than ISP) (SCPP = MAP – ISP). Vessel injury (decreased local blood flow delivery), hypotension (decreased MAP), and obstruction to blood flow (either segmental or elevated ISP) will decrease SCPP. Methods to maximize SCPP include setting elevated MAP goals to maximize delivery, and recent studies have demonstrated utility of intraspinal pressure monitoring and cerebrospinal fluid drainage to minimize obstruction to blood flow (10,11).