Conservative or surgical treatment: There is biological evidence from experimental studies that early decompressive surgery may improve neurological recovery after SCI, although the relevant interventional timing in humans remains unclear. Role of surgical decompression or conservative treatment in spinal injuries is only supported by class III and limited class II evidence. Most of the better planned and recent studies in favor of conservative treatment have been on neurologically intact patients. Surgery for spinal injury can thus only be considered as an option. This may be for want of a well designed prospective randomized controlled clinical study, which needs to be done. We know that there are inherent problems in doing such a study. Patients with SCI managed conservatively need to be in bed for a specified duration during which they require meticulous care. With the inadequate and unsuitable management infrastructure, paucity of trained personnel and unsuitable climatic conditions in our country, surgical stabilization and mobilization may provide better results. However, there is a need for a proper study in this regard. When to operate: Even though there has been evidence for and against early surgery, it should be done only after the patient is stable and other associated conditions warranting priority treatment have been dealt with. However, an endeavor should be made to operate as early as possible.