The treatment of traumatic spinal cord injury (SCI) remains challenging due to its complex pathophysiology and lasting disabilities, including socioeconomic burdens. While current strategies focus on timely surgical interventions and haemodynamic management, recent research in SCI is advancing rapidly, investigating neuroprotective methods and novel biologics. This chapter examines advancements in SCI management, emphasising the “Time is Spine” paradigm for timely surgical decompression. We also address the debated role of steroids, noting their risks and limited benefits. Emerging pharmacological and non-pharmacological neuroprotective strategies, such as therapeutic hypothermia, are discussed. The chapter also sheds light on stem cell therapies and neuromodulation techniques as promising upcoming strategies for promoting neuroregeneration and recovery. Long-term rehabilitation, requiring a multidisciplinary approach, is essential to optimise outcomes, and various strategies proven to be beneficial in SCI have also been highlighted. Overall, translating proposed innovative management strategies into clinical practice requires further research, robust trials, and collaboration. However, these discoveries are expected to revolutionise SCI management in the next decade if proven beneficial.