In this review, important factors related to initial management, diagnosis, airway, and anesthetic management of patients with cervical spine injury (CSI) are discussed. Early diagnostic and clinical evaluation is important in excluding CSI. In-line stabilization reduces movement of the cervical spine. Tracheal intubation under fiberscopic control, offers safety, and comfort to the patient. However, in cases of severe deterioration of vital functions, intubation must be performed without any delay at the site of the accident or in the emergency room. Early airway management and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique. The current opinion is that oral intubation after intravenous induction of anesthesia and muscle relaxation along with in-line stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI.