Publisher Summary This chapter discusses the etiology, clinical aspects, diagnosis, and treatment of spinal stroke. The main predisposing factor for spinal cord ischemia (SCI) is the surgical repair of a thoracoabdominal aortic aneurysm (TAAA). This most devastating complication remains the foremost problem for 0.5 to 38% of such operations. The presumed mechanism for SCI is the occlusion of the intercostal artery that gives its origin to the anterior spinal artery (ASA). In approximately 85% of the population, the ASA arises from the left lower intercostal arteries favoring, therefore, that dissecting TAAA with a left-sided false lumen will have a higher frequency of SCI. The method of choice for diagnosing spinal cord ischemia or infarct is magnetic resonance imaging (MRI). Improvement of surgical and cord protection techniques has resulted in preservation of spinal cord circulation and survival. Utilization of profound hypothermia, intraoperative electrophysiologic monitoring, reanastomosis of blood vessels particularly intercostal arteries, reduction of clamp time, and more recently the introduction of distal aortic perfusion and continuous cerebrospinal fluid (CSF) drainage, have reduced significantly the development of postoperative neurological deficit.