This chapter provides a detailed examination of spinal anatomy and biomechanics with a specific focus on clinical applications in spinal cord medicine. The text begins with embryonic development of the vertebral column and spinal cord, describing the formation of neural structures and skeletal elements from the third week of human development. This developmental foundation establishes the basis for understanding both normal anatomical variations and potential pathological conditions. Surface anatomical features are examined in detail, offering clinicians specific reference points for physical examination and diagnostic procedures. This chapter then presents a comprehensive analysis of regional spinal anatomy, including cervical, thoracic, and lumbar sections. Each region receives focused attention regarding its unique structural characteristics, biomechanical properties, and clinical significance. The biomechanical section analyzes spinal movement patterns, load transmission, and stability mechanisms. This includes examination of coupled motions, the role of ligamentous structures, and muscular systems that maintain spinal alignment. Special attention is given to the functional relationships between vertebral segments and their supporting structures. Detailed coverage extends to the vascular anatomy of the spine, particularly the vertebral arteries and venous drainage systems. The text examines anatomical variations and their potential clinical implications, supported by current research findings. Neurological elements receive similar attention, with analysis of nerve root anatomy and patterns of innervation. The muscular systems affecting spinal movement are presented systematically, organized by functional groups and their contributions to specific movement patterns. This includes the examination of deep stabilizing muscles as well as larger superficial muscle groups that produce gross movements of the trunk and neck. Throughout this chapter, emphasis remains on clinical applications relevant to spinal cord medicine. While not addressing spinal pain management directly, the anatomical and biomechanical principles presented form the foundation for informed clinical decision-making and development of rehabilitation strategies for patients with spinal cord injuries.