Spinal cord ischemia usually results in substantial neurological morbidity. It is usually encountered after complex aortic surgery and when the procedure has been acute, such as in an aortic dissection. Most patients with spinal cord ischemia present with acute flaccid weakness, sensory level, and sphincter dysfunction. Treatment options using lumbar drainage to reduce cerebrospinal fluid pressure are discussed in this chapter. Spinal cord infarction is often disabling, but some patients can still achieve a favorable functional outcome despite initial severe deficits.