In the United States, injuries are the leading cause of premature lost years of life, surpassing cancer and heart disease combined. Public health surveillance of injuries such as spinal cord injury (SCI) has recently begun to evolve, following decades of experience with similar methods for infectious and chronic disease conditions. In 1985, the Federal Government's Centers for Disease Control began to promote the development of surveillance systems for sentinel injuries at both the state and national level. Many states have developed, or are in the process of developing, statewide registries for SCI. The rationale behind the establishment of these registries is 4-fold: (1) to identify SCI persons in order to facilitate and coordinate provision of health and other services; (2) to gather accurate data for injury prevention efforts and planning for needed services; (3) to evaluate services provided, and (4) to document outcome and cost-effectiveness of care systems. The purpose, content and scope of these registries are reviewed in detail.