Spinal cord injury produces a sudden and devastating effect on the patient. The reversal of paralysis following SCI is among the most daunting challenges in medicine. Surgery can align the spine and remove compression of neural elements. However, there is no clear-cut evidence that this can improve the final neurological outcome. The focus in the last few decades has been on pharmacological treatment of SCI. Following SCI, a series of pathophysiological changes occur in the cord tissue. Drugs can act by counteracting this damage by different mechanisms so that the neuronal function can potentially be improved. There have been many drugs, which have undergone animal and human trials for treatment of SCI. However, there has been controversy regarding efficacy of this drugs. Quite a few trials have shown promising results, but critical appraisal questioned the quality of these trials. Research in last few years has been focused at finding newer compounds and improving the quality of clinical trials.