A prospective multicenter clinical trial in 58 participants with acute spinal cord injury (mean age 51 years) tested drainage of cerebrospinal fluid via a lumbar catheter to maintain a spinal cord perfusion pressure (SCPP) ≥ 65 mmHg, compared with a historical group of 86 patients managed according to a mean arterial pressure (MAP) of 85–90 mmHg. The catheter was inserted at 138 hours (95% CI 129–147) and 495 mL of fluid (95% CI 350–641 mL) was drained, but none in seven patients. No significant differences were found in hemodynamic parameters such as intrathecal pressure (ITP) or SCPP between groups, nor in neurological recovery after 6 months (p=0.897). The study was terminated due to inconsistent adherence to the protocol at eight sites. The intervention group had more ITP pulse wave recordings (p=0.006) and fewer hours on vasopressors (p=0.004), with 6 adverse events related to the intervention. The protocol resulted in little fluid depletion and no effect on recovery.