Traumatic spinal cord injury (SCI) can be a devastating neurologic event that often results in severe somatic and autonomic dysfunction requiring multidisciplinary care. The incidence of traumatic SCI is significant, with approximately 17,500 new cases annually in the United States (National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. University of Alabama at Birmingham, Birmingham, AL, 2017). It primarily affects young adults, although there is an increasing trend of SCI affecting older populations (Stein and Sheth, Contin: Lifelong Learn Neurol 21:159–187, 2015; Ahmad et al. World Neurosurg 82:207–214, 2014). The lifetime costs for managing SCI can range from an estimated $1.1 million to $4.8 million per person, depending on the severity and age of onset, leading to substantial physical, emotional, and financial burdens (National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. University of Alabama at Birmingham, Birmingham, 2017). Cardiovascular complications are one of the leading causes of death in individuals with SCI during both the acute and chronic phases of injury (Phillips and Krassioukov, J Neurotrauma 32:1927–1942, 2015). Hemodynamic instability can exacerbate spinal cord injury, leading to worse outcomes and increased mortality (Ropper et al. Pr Neurol 15:266, 2015; Stevens et al. J Neurosurg Anesthesiol 15:215–229, 2003). Therefore, adequate hemodynamic monitoring and management are crucial for preventing secondary complications and improving neurological outcomes in SCI patients. This chapter reviews the hemodynamic changes, monitoring techniques, management strategies, and cardiovascular complications in SCI.