This chapter discusses about the management of spinal injury. Spinal cord injury (SCI) is devastating for the patient and family. They cause immense physical, psychological and functional disability. Spinal cord injury are mainly due to motor vehicle accidents, falls and sports injuries. Primary injury and secondary injury are the two types of spinal cord. Neurological assessment and associated injuries are the clinical features of spinal injury. X-ray, computerized tomography and magnetic resonance imaging are play important role in spinal injury. Clearance of cervical spine in unconscious ICU patients remains controversial with no standard approach. Prehospital management, emergency management, hospital/ICU management, respiratory management, cardiovascular management, neurological management and skeletal management are management of spinal injury are also discussed in this chapter.