Study design: Intraoperative power Doppler ultrasonography was used to evaluate the spinal cord blood¯ow in cervical spondylotic myelopathy patients during hypotensive anesthesia. Objective: To evaluate the e ect of prostaglandin E1 (PGE1) induced hypotension on spinal cord blood¯ow (SBF) during spinal surgery. Summary and background data: Hypotension is frequently induced to decrease blood loss during surgery and to diminish the need for blood transfusion. Prostaglandin E1 (PGE1) is reported to maintain cerebral, liver, and renal blood¯ow during surgery. However, there are few reports on spinal cord blood¯ow. Methods: Eleven patients underwent laminoplasty for cervical spondylotic myelopathy. After a French door type laminoplasty was carried out, hypotension was induced with PGE1. Before and during hypotension, we evaluated blood¯ow in the anterior spinal cord artery by determining the pulsatility index (PI) and resistance index (RI) using power Doppler ultrasonography. Results: Before hypotension, the mean blood pressure was 80 mmHg. The blood pressure decreased to 60 mmHg using PGE1 (P50.01), although the PI and RI were signi®cantly higher than before hypotension (PI, P=0.0076 RI, P=0.02). Conclusion: The pulsatility and resistance indices during hypotension were signi®cantly higher than before hypotension, suggesting that the autoregulation of the anterior spinal cord artery and anterior spinal cord blood¯ow were maintained with hypotension using PGE1. Prostaglandin E1 may be a useful drug for hypotensive anesthesia in spinal surgery. Spinal Cord (2001) 39, 31 ± 36