Early surgical intervention for cervical spinal cord injuries was thought to be detrimental in Japan because it is difficult to judge the relative merits of surgical treatment compared with conservative management. As the improvement of paralysis is not expected in cases of complete cervical cord injuries, surgical intervention was seldom applied. However, there are several reports describing that reduction within 4-6 hours after injury in patients with cervical spine dislocation enables good neurological recovery from complete quadriplegia. Therefore, surgical decompression and stabilization in a short period of time after injury may also prevent permanent neurological damage in patients with complete cervical cord injuries with burst fractures or without radiographic evidence of bony trauma. In order to complete surgical decompression rapidly and safely in the very early phase after cervical cord injuries, and to manage the various perioperative complications, a multidisciplinary team approach with orthopedic surgeons, an operating theater, an intensive care unit, and a rehabilitation team is required.

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　　Among pelvic ring injuries, sacral fractures in particular carry a high risk of massive bleeding, nerve damage, and soft tissue damage, and thus pose many treatment dilemmas. Moreover, sacral fractures differ widely from patient to patient in terms of fracture site, form, and instability, and treatment plans must take both the general patient condition and the local state into consideration. As treatment for these fractures, for the most common lateral compression type of damage, which features little dislocation of fracture fragments and anterior impaction, conservative treatment has become the standard. On the other hand, for fully unstable fractures resulting from fall injuries, the stabilization of the fracture by external fixation is difficult, and it is now known that, without firm internal fixation, postoperative dislocations lead to adverse effects on the functional prognosis. To treat cases with concomitant nerve damage, although conservative medical treatment alone can lead in some cases to natural recovery from neuropathy, an increasing number of reports support early surgical stabilization and fracture decompression. The development of future research and treatment strategies is awaited.

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