The cervical spine is injured in 2 to 3% of blunt trauma victims. Injuries may range from minor ligament strains to complete fracture-dislocations resulting in severe spinal cord injury. Approximately two-third of all fractures and three-fourth of all dislocations involve the subaxial spine. Approximately 40% of these patients will have an associated neurological injury. The most common causes of SCI are motor vehicular accidents, falls from height, fall of a heavy object on the head, and violence- and sports-related injuries. The management of patients with cervical injuries involves three phases, including prehospital care, emergency in-hospital care and the definitive treatment. In countries such as the United States, improvements in patient retrieval methods, the use of effective restraints including airbags and enforcement of drunk driving laws have resulted in a lower incidence of SCIs and a higher proportion of incomplete rather than complete SCIs. Improvement in prehospital and emergency in-hospital care has also resulted in an improved prognosis for survival and possibly even recovery from incomplete neurologic injury. This chapter aims to discuss current concepts in the in-hospital care of the patient including the clinical assessment, the radiological assessment, the role of steroids and closed reduction as well as the indications for surgery and the appropriate surgical approach based on the pattern of injury.