The choice of surgical approach in the management of individuals with SCI is dependent on a myriad of factors. These include individual age and comorbid status, the location of injury, the severity of neurologic injury, the extent of cord compression and any mechanical instability. In general, there is a need to decompress the spine in cases of canal compromise and to stabilize the column. At any level of the spine, one may choose to perform a laminectomy for decompression; this is most commonly accompanied by spinal fusion. In the cervical spine, posterior decompression may be accompanied by the placement of lateral mass screws or with the addition of an anterior cervical discectomy and fusion. Thoracolumbar fractures that cause incomplete injury, ongoing cord compression and instability are most frequently treated by laminectomy and fusion. If there is no need for decompression, one may choose a percutaneous instrumentation technique.