This chapter basically talks about the acute vertebral pain. Severe acute pain overlying the spine has numerous causes. A thorough history, physical examination, laboratory tests, and imaging studies are necessary to rule out referred pain from the abdominal and thoracic viscera. Patients with acute vertebral pain after trauma expeditiously undergo neurologic examination and imaging studies. Patients with acute and significant neurologic compromise or instability revealed on the magnetic resonance imaging (MRI) are emergently evaluated by a neurosurgeon for possible decompression and stabilization. After diagnosis and neurologic evaluation and imaging studies, neurosurgical consultants evaluate the patient for early (<24 hours) decompression to prevent long-term neurologic deficits.