This chapter includes a broad overview of spinal and spinal cord trauma from the perspective of trauma surgery. Topics covered include epidemiology, anatomy, physiology, common injury patterns, evaluation, management, and prognosis. In brief summary, injuries to the spine and spinal cord are common in those with major polytrauma, with common mechanisms being motor vehicle collisions and falls. The spinal column, divided into the cervical, thoracic, and lumbar lesions, consists of bony vertebrae with associated ligaments protecting the spinal cord and associated nerve roots. Physiologic effects of spinal cord injury may include sensory deficits, motor deficits, pulmonary impairment, cardiovascular compromise, and effects on other organ systems. Spinal injuries are classified by spinal level and completeness of spinal cord injury. Specific fracture patterns are related to mechanism of injury, stability and need for operative fixation, and associated non-spinal injuries. Evaluation consists of a comprehensive neurologic examination and imaging according to clinical decision-making rules. Management is according to Advanced Trauma Life Support principles initially, with subsequent attention to spinal immobilization, cardiopulmonary stabilization, prophylaxis, and prompt consultation with a spine surgeon with regard to nonoperative versus operative management. Chronic complications of spinal injury include pain as well as major neurologic and non-neurologic sequelae of spinal cord injury