Each year, some 12,000 Americans are rendered paraplegic or quadriplegic by spinal cord injury. Most of these injuries result from motor vehicle accidents, falls, and sports-related trauma. Although the short-term and long-term prognosis for paraplegic and quadriplegic patients has improved in recent years, an alarmingly large number of these patients die before or during initial hospitalization. The following article has been prepared to help clinicians understand and manage patients with spinal cord injuries. It reviews the pathophysiology of spinal cord trauma, especially that involving the cervical region, and discusses the treatment of this condition from a critical care, rather than a neurosurgical, point of view.