Study design: Retrospective study. Objectives: To review traumatic spinal cord injury (TSCI) rates and epidemiology at the Riyadh Military Hospital (RMH) in Saudi Arabia and to hypothesise strategies for a more integrated approach to injury prevention in Saudi Arabia. Setting: RMH, Rehabilitation Division. Methods: A review was conducted of all patients with TSCI aged X14 years admitted to RMH from January 2003 to December 2008. Descriptive analysis was performed for age, gender, cause of TSCI, completeness and neurological level of the injury. Results: In all, 307 TSCI patients were admitted during this period: 88% were male, and their mean age was 29.5 years old (median 27, range 14-70). Of all TSCI patients, 52% had tetraplegia and 51% had a complete TSCI. Road traffic accidents (RTAs) were the main cause of TSCI (85%). Conclusions: TSCI in Saudi Arabia affects mainly the male population. The rate of RTAs caused by four-wheeled vehicles is the highest globally reported RTA statistic. Primary prevention strategies specific to the region should be developed to decrease the number of car accidents. The higher-than-expected rate of complete injuries may reflect practices in acute management and transport, and suggests that a review of the acute and integrated management of TSCI may also be necessary.