A missed spinal injury is defined as an injury that has been overlooked or misdiagnosed during the initial clinical or radiological assessment resulting in inappropriate or delayed treatment. An undetected injury can have devastating long-term consequences, including pain, deformity, paralysis and death that also carry significant cost and resource-related implications for society. Lack of infrastructure, financial constraints, delayed presentation and lack of established protocols for assessment has led to a higher incidence of overlooked injuries in the developing nations. Early recognition of these injuries may prevent or limit neurologic compromise and optimize eventual functional restoration. More than 10 million patients present to emergency departments in the United States for evaluation every year. Although, the incidence of spinal injuries amongst blunt trauma victims presenting to the emergency department is low (2-6%), misdiagnosis of these injuries is not uncommon (4-30%). This chapter deals with the epidemiology, the causes and consequences of MSI as well as the prevention by using established protocols for spine clearance.