We appreciate the insightful comments of Dr. Nelson1  and the opportunity to respond to him as it relates to our recent Clinical Focus Review on the “Perioperative Management for Complex Spine Fusion Surgery.”2  In his letter, Dr. Nelson relates concern regarding our discussion of the predictive potential of pulse pressure variation in this particular cohort of patients.1  The word limits for this type of review did not permit us to provide a comprehensive discussion or evaluation of each component of perioperative anesthesia management for complex spine surgery, and so we appreciate this opportunity to expand on the topic of volume assessment for fluid therapy in the prone position in these patients.

Bernard Baruch, financier and advisor to several U.S. Presidents through two world wars once quipped, “A speculator is a man who observes the future, and acts before it occurs.” The role of our individual intraoperative monitoring...

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