There is considerable confusion and controversy regarding the incidence of radiologic abnormalities, prognosis and pathomechanics of spinal cord injuries in children. The comparison of mechanisms of injury, severity of trauma, methods of management and outcome has been difficult because some have used 12 yr as the upper age limit, while others have included patients as old as 18 yr. The neurologic patterns of injury, radiologic features, management, outcome and pathomechanics in 97 children with acute spinal cord injury are critically analyzed.