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The study cohort was divided into a group of patients in whom acute kidney injury developed after carotid endarterectomy and a group of patients in whom acute kidney injury did not develop after carotid endarterectomy. Acute kidney injury was defined as an acute increase in the serum creatinine level of at least 0.3 mg/dL or a 50% or greater increase in the baseline level from the previous measurement. Acute kidney injury developed after 29 (0.7%) of 4247 carotid endarterectomies. All of the acute kidney injuries occurred in patients with severe symptomatic internal carotid artery disease, including 34 of 35 (97%) patients with a 30% or greater luminal narrowing and 26 of 32 (81%) patients with a 50% or greater luminal narrowing. The patients who developed acute kidney injury had significantly greater blood loss and longer operative times compared with patients who did not develop acute kidney injury. 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Injury to the spinal cord has a devastating impact on both the individual and the family. The injury usually results in quadriplegia or paraplegia, and death frequently follows shortly after injury. Treatment options are limited, and the potential for permanent damage to the spinal cord is high. The treatment of acute spinal cord injury, with the goal of reducing secondary degenerative changes and promoting neural regeneration, must include stabilization of the spinal column and protection of the injured spinal cord. Any delay in applying these measures may increase the probability of secondary injury. Surgery is indicated for patients with incomplete spinal cord injury in whom a high level of neurological recovery is not likely. Surgery should be performed in the shortest time possible. The prevention of secondary injury includes minimizing intracranial pressure and preventing edema; controlling seizures; preventing transection of blood vessels; and maintaining adequate blood flow and oxygenation of the spinal cord. Completeness of the injury, the mechanism of injury, and the patient's neurologic level, as assessed by the American Spinal Injury Association (ASIA) classification, are used to determine which treatment options are appropriate. Decisions regarding whether to place patients with injuries higher than T2 in the prone or supine position must be individualized and be made on a case-by-case basis. Over the last decade, the management of acute spinal cord injuries has changed radically. As a result of changes in the acute management of injuries, secondary injuries have been reduced and neural recovery has been increased. 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