Spinal cord injury (SCI) is a devastating, life-threatening condition that produces a number of physiologic and anatomical derangements that must be acutely managed by the anesthetic team. This chapter presents a case study of a 26-year-old male with a loss of sensation and motor control from the neck down. The patient was scheduled for an immediate posterior cervical decompression and stabilization by the neurosurgical service. The patient was evaluated in the emergency room for other associated injuries and high-dose methylprednisolone was started. Maintenance of anesthesia included propofol and remifentanil infusions, in order to facilitate spinal cord monitoring with somatosensory and motor evoked potentials. The postoperative care of these patients might be extensive requiring multiple further anesthetics. Anesthesiologists must be familiar with the unique long-term complications of SCI such as spasticity, autonomic hyperreflexia, and chronic ventilator support that may alter anesthetic management.