The spinal cord extends from the base of the skull to the first lumbar vertebrae from which it continues as cauda equina. Injuries to the spinal cord can lead to significant short- and long-term morbidities. Depending on the level of injury, morbidities may include acute hemodynamic changes, weakness of respiratory muscles and ventilator dependence, and loss of bowel and bladder function. Acute spinal cord injury with cord compression is a surgical emergency. Important anesthetic implications include airway stabilization and management, fluid management, and maintenance of spinal cord perfusion pressure at all times.