We present a case of paraplegia, compatible with spinal cord ischemia, following percutaneous nephrolithotomy in a 58-year-old male under the diagnosis of left renal stone. After retroperitoneal operative procedures in the prone position, sensory loss below the level of T4, paraplegia and transient loss of visual acuity were developed. These clinical findings reflect ischemia of the anterior spinal cord with complete motor paralysis and sensory loss to T4 dermatomal level resulting from an anterior spinal artery syndrome. The initial treatment was started with intravenous heparin and corticosteroid. At present, sensory loss is almost recovered and motor deficit is remarkably improved to a level of ambulation with cane. The patient is still treated with oral coumadine and neuromotor rehabilitation. The cause of spinal cord ischemia is unknown, but we speculate ischemia of the spinal cord was associated with embolism and spasm or trauma of feeding artery (ies) of Adamkiewicz.