Class III medical evidence supports the aggressive medical management including ICU care of all patients with a spinal cord injury, including those with ATCCS. Class III medical evidence suggests that surgery for ATCCS is safe and appears to be efficacious (in conjunction with medical management) for patients with focal cord compression, or to provide operative reduction and internal fixation and fusion of cervical spinal fracture dislocation injuries. The role of surgery for patients with ATCCS with long segment cord compression/injury or with spinal stenosis without bony injury remains a subject of debate in the literature. 19,23,26,27,31,37,38,81,94-101 Patient age and comorbidities are important factors when considering surgical treatment for patients with ATCCS.19,22,26,28-29,33,35,81,84,85. © 2013 by the Congress of Neurological Surgeons.