The ideal management strategy for patients with acute central cervical spinal cord injuries seems to be multifaceted. As Schneider et al. (20) insisted years ago, a rapid, accurate diagnosis is essential. A detailed clinical examination, cervical spinal x-rays to assess vertebral column injury (see recommendations in Chapter 5), and MRI assessment of the cervical spinal cord for intrinsic injury and/or compression will accomplish this goal. Many of these patients may require management in the intensive care unit setting (see recommendations in Chapter 7) for monitoring and treatment of cardiac, pulmonary, and blood pressure disturbances. Blood pressure augmentation to mean arterial blood pressure levels of 85 to 90 mm Hg may be of benefit (see recommendations in Chapter 8). Early reduction of fracture or fracture-dislocation injuries should be accomplished (see recommendations in Chapter 20). Administration of pharmacological agents may be of benefit according to specific parameters (see recommendations in Chapter 9). Surgical decompression of the compressed spinal cord, particularly if the compression is focal and anterior and is approached anteriorly, seems to be of benefit in selected patients.