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Further research into this treatment approach could reveal a role of adjunctive methotrexate in the management of such injuries. © 2020 Published by Elsevier Inc.Background During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to par