Spinal injury must be suspected in every unconscious patient at the scene of accident. During medical stabilization, the patient is immobilized so that assessment and treatment can be safely performed. Inadequate precautions during transportation can cause further injury. Spinal shock refers to the flaccidity and loss of reflexes seen after spinal cord injury. Neural shock refers to sympathetic paralysis and require fluid restriction. 50-60% of patients with SCI have incomplete spinal cord injuries. The recommended pharmacological management for patients with spinal cord injury presenting within 3 hours of injury is a loading dose of methylprednisolone of 30 mg/kg over 15 minutes intravenously, followed by a pause of 45 minutes and then 5.4 mg/kg/h for the next 24 hours; the 5.4 mg/kg/h is extended for 48 hours for those who present within 3-8 hours. Early surgical stabilization is beneficial in terms of reducing complications, length of stay and early mobilization. Patients with incomplete injuries have a greater probability of experiencing some functional recovery, whereas those for complete injuries are very modest at best. Long-term treatment include general health promotion, relief from exacerbating factors, psychotherapeutic interventions, non-narcotic pharmacologic treatment, narcotic treatment, physical therapy and rehabilitatory surgical intervention. Stem cell therapy holds promise.