The majority of the nearly 18,000 new cases of spinal cord injury in the United States each year involve the cervical spine. Although the morbidity, mortality, and healthcare costs associated with these injuries is very high, quality evidence to guide emergency management is limited. Recent changes to guidelines have called into question decades of practice, including prehospital spinal immobilization protocols, timing of surgery, and pharmacotherapy. A systematic approach to the diagnosis and management of the spine-injured patient is outlined in this review, with a focus on recent updates and management of emergent complications.