There is substantial doubt as to the value of "decompressive" surgery in the management of spinal cord injury. A few relative indications exist for such surgery, but they are only relative. There are a number of absolute contraindications to the procedure, and it should be undertaken only under the most unusual and highly selected circumstances. It would seem that stabilization of the spine may be more important. It behooves us to look more carefully at our concepts of "stable" versus "unstable" fractures.