Although spinal cord injury (SCI) is approximately one-tenth as common as traumatic brain injury, its effects, at both a personal and societal level, are particularly devastating. At present, there is no single therapy that has demonstrated a uniform ability to improve neurological outcomes for SCI patients at long-term follow-up. In spite of this, the last 30 years have borne witness to numerous incremental advances within the field of spinal trauma including the incorporation of standardized neurological assessment tools, the completion of several large therapeutic efficacy trials and the development of modern day surgical classification systems. In this article we review the current evidence surrounding the medical and surgical management of SCI, as well as identify areas where future research is needed.