Objective: To determine the hemodynamic conditions associated with optimal neurological improvement in acute traumatic spinal cord injury (SCI) individuals who had lumbar intrathecal catheters placed to measure cerebrospinal fluid pressure (CSFP). Methods: Ninety-two acute SCI individuals were enrolled in this multi-center prospective observational clinical trial. We monitored mean arterial pressure (MAP) and CSFP during the first week post-injury, and assessed neurologic function at baseline and six-months post-injury. We used relative risk iterations to determine transition points at which the likelihood of either improving neurologically or remaining unchanged neurologically was equivalent. These transition points guided our analyses where we examined the linear relationships between time spent within target hemodynamic ranges (i.e., clinical adherence) and neurological recovery. Results: Relative risk transition points for CSFP, MAP, and spinal cord perfusion pressure (SCPP) were linearly associated with neurological improvement and directed the identification of key hemodynamic target ranges. Clinical adherence to the target ranges was positively and linearly related to improved neurological outcomes. Adherence to SCPP targets, not MAP targets, was the best indicator of improved neurological recovery, which occurred with SCPP targets of 60-65 mmHg. Failing to maintain the SCPP within the target ranges was an important detrimental factor in neurologic recovery, particularly if the target range is set lower. Conclusion: We provide an empirical, data-driven approach to aid institutions in setting hemodynamic management targets that accept the real-life challenges of adherence to specific targets. Our results provide a framework to guide the development of widespread institutional management guidelines for acute traumatic SCI.