There is little consensus regarding the necessity, timing, nature or approach of medical and surgical interventions in spinal cord injury. In vitro studies, animal models, and clinical outcomes analyses have all failed to yield standards that define the roles of surgery and pharmacotherapy. Intuitive hunches and anecdotal accounts have not been corroborated by scientific studies, and both individual and institutional preferences abound. Although the AANS/CNS Joint Section on Trauma has recently published the Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries, we perceived the need for a didactic book summarizing the scientific foundations of surgical practice, based upon a critical appraisal of the quality of published literature. The book differs from existing texts in fundamental ways and does not attempt to duplicate what has already been written. Unlike those that appeal to a broad audience, this volume assumes a level of sophistication and is specifically addressed to orthopedists, neurosurgeons and others with considerable experience in SCI. ITs scope is confined to controversial topics in the practical management of cord-injured patients as well as the relevant background for such deliberations.