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The occurrence of hypotension has been shown to be associated with worse outcomes after traumatic injury, including severe head injury. To our knowledge, a prospective controlled assessment of the effects of hypotension on acute spinal cord injury (ASCI) in humans has not been performed. Animal models of ASCI have been created in laboratory and data is extrapolated to the clinical setting, suggesting that hypotension contributes to secondary injury after ASCI by reducing spinal cord blood flow and perfusion.Given the lack of conclusive evidence on the topic, we set out to perform a comprehensive review of the pertinent evidence, first of the animal models on which the current guidelines are based, followed by a review of the human clinical data which is available. The goal was to assess the merit of the current guidelines and ascertain the correct target MAP immediately after ASCI as well as the duration for which this MAP must be targeted.