Post-traumatic malposition of the spine usually results in inadequate conservative treatment or incorrect surgical therapy. The main indication for secondary reconstructive measures in pain. Besides the predominant vertebragenic causes, neuropathic forms may be combined in spinal cord damage. Secondary neurological damage or progressive neurological deficits are combined with persistent spinal compression or increasing (mostly kyphotic) malpositions. The objective of the surgical treatment is to correct the malposition with reprofiling the spine and restoration of the stability of the axis organ. Attention must be paid to primary or secondary spinal lesions, since additional neurological lesions can be provoked when the strategy is wrong, and concomitant or prior neurosurgical interventions may become necessary. Almost exclusively, the objective of our reconstructive measures with reprofiling of the injured spine avoiding damage to healthy movement segments can be achieved only by a combined ventral and dorsal operation. The crucial shortcomings result from the first treatment. Acceptable treatment results can only be expected in both first and secondary treatment of spinal cord injuries when the following factors are taken into consideration: (1) pretherapeutic definition of the injury pattern; (2) the functional anatomy of the spine (load sharing and tension band principle); (3) mastery of all approaches (dorsal, dorsolateral, ventral) and the instrumentation.