Iatrogenic spinal cord injury (ISCI) is a serious complication of spinal surgery, which fortunately occurs rarely. The incidence varies depending on the pathology and region of the spine being treated and the overall incidence has been observed to be below 0.5%. The SCI could be due to direct mechanical injury or a vascular injury or a combination of the two modalities. The best and most cost-effective way of managing ISCI is preventing its occurrence in the first place. A systematic and thorough preoperative assessment, paying meticulous attention towards the surgical technique, and utilization of relevant preoperative and intraoperative imaging modalities are valuable strategies in reducing the incidence of iatrogenic spinal cord injury. Additionally, intraoperative neuromonitoring is recommended for deformity and tumor surgery. If a neurophysiological deterioration occurs during a specific surgical maneuver (screw insertion, distraction, compression or correction), the precipitating maneuver should be reversed. A combination of imaging modalities, which include radiographs, computed tomography scans, myelogram and magnetic resonance imaging scans, may be required to rule out a case presenting with compression from a spinal epidural hematoma, from that presenting with compression due to a misplaced implant or inadequate decompression. In this case, a prompt evacuation or removal of the compressive element is recommended. If a compressive element is not visualized on imaging, intrinsic cord damage or a vascular insult may be responsible for producing the neural deficits. Careful hemodynamic and neurological monitoring in an intensive care setting is advisable after the surgery. The role of steroids in this setting is controversial.