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Spinal cord injury is (SCI) a catastrophic event and one of the most common causes of severe disability and death following trauma. Successful outcome from a traumatic spinal cord injury (SCI) depends heavily upon the quality of the acute care rendered to the affected individual. In recent years, there have been significant advances in the acute ement of SCI. Although life expectancy has improved greatly in patients with SCI, there is still further room for improvement. Almost every aspect of the management of SCI is controversial, due in part to a lack of good-quality evidence. The current management strategies in the areas of prehospital care and transport, emergency room management, surgical considerations and pharmacotherapy are discussed.