Trauma victims with cervical spinal cord injuries should be managed by proper immobilization and immediate reduction of spinal cord fractures to anatomical alignment. Patients must be stabilized medically, and a thorough neurologic and radiographic evaluation must precede any surgical intervention. Treatment must be individualized and depends on the level and severity of injury. New pharmacotherapies under intensive investigation offer some hope of recovery of function to patients with spinal cord injuries. Recent clinical trials with methylprednisolone indicate that the sensory and motor outcome of patients subject to trauma with spinal cord injuries improved when they received high doses within 8 hr of injury. Clinical trials are being proposed with tirilizad, a member of a new family of drugs, the 21-aminosteroids. This agent, which may be even more effective than methylprednisolone, has none of the side effects associated with other steroids.