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Reader response: Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury

Squair et al.1 proposed that maintaining spinal cord perfusion pressure (SCPP) above 50 mm Hg and monitoring intrathecal pressure led to improved outcome but did not correlate with mean arterial pressure (MAP) or intraspinal CSF pressure. The 2013 update of guidelines for acute cervical spine and spinal cord injuries management advocated maintaining MAP about 85–90 mm Hg using even double inotrope support.2 SCPP is a dynamic process and may be higher for hypertensive patients and widespread microvascular disease; remains changing in the same traumatic spinal cord injury case; and intraspinal pressure value may be variable across the injury segment because cord edema, hematoma, and vertebral body fracture segments may impede free circulation of CSF.