The cervical spine is vulnerable because of its anatomical mobility and complexity. These features also make cervical trauma management difficult and nuanced. Management decisions are made with the aid of experience, evidence and patient input. In order to improve our knowledge of the available evidence, a new edition of Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injury was published as a Neurosurgery supplement in March 2013. This edition provides seventy-six guideline updates and thirty-six new evidence-based recommendations. Nineteen recommendations are supported by Level I (randomized control trial) studies. Key highlights are that the guidelines do not recommend methylprednisolone for treatment of acute spinal cord injury and that angiography is recommended in select patients with cervical spine injury to evaluate for vertebral artery injury. This is a ‘must read’ for the practicing neurosurgeon as the guidelines represent a rigorously analyzed and ranked compilation of the best available current evidence to aid in the clinical management of these complex injuries.