In the UK, blood pressure management after acute, severe traumatic spinal cord injury (TSCI) is variable.1 The American Association of Neurological Surgeons (AANS) recommends maintaining mean arterial pressure (MAP) at 85–95 mm Hg for a week after injury, but with little supporting evidence.2 To rationalise blood pressure management, we monitored intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP=MAP−ISP) from the injury site.3 Our technique is safe4 and analogous to monitoring intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in traumatic brain injury (TBI). The data indicate that, after TSCI, ISP rises and SCPP falls.3 Here we show strong correlation between high ISP or low SCPP and reduced neurological recovery. Our findings raise the possibility that interventions to reduce ISP or increase SCPP after TSCI may improve neurological outcome. ### Patient recruitment Approval for this observational cohort study was granted by the National Research Ethics Service London–St Giles Committee. Inclusion criteria are: (1) Severe TSCI defined as American spinal injuries association Impairment Scale (AIS) grade A, B or C; (2) Age 18–70 years; (3) Timing between TSCI and surgery within 72 hours. Exclusion criteria are: (1) Patients unable to consent; (2) Other major injuries or comorbidities; (3) Penetrating TSCI. Surgery and early management took place at St. George's Hospital. Consent was obtained by each patient. ### Surgery Following bony realignment and posterior fixation, the ISP probe (Codman, Depuy Synthes, Leeds, UK) was tunnelled through …
