The average age of the population is increasing and spinal traumatic injuries of the elderly are significantly more common. This frail population is prone to suffering serious injuries from minor or low-impact trauma when compared to younger patients. The reduced agility and ability to avoid falls in the elderly population may be the result of a combination of decreased stability due to altered sensory mechanisms, progressive spinal deformity, increased rigidity, osteoarthritis and neurological disorders, reduced cognitive function and hypotension, along with polypharmacy. Associated risk factors, including metabolic and autoimmune conditions may significantly increase the risk of morbidity and disability in this group. The most frequent injuries are odontoid fractures, vertebral compression fractures and traumatic central cord syndrome, all of which may be frequently associated with other lesions. Patient resilience and expectations will determine selection of consensual treatment aiming for a balance between maintaining function and achieving recovery. Conservative management is often the preferred method of treatment in the most common spinal injuries in the elderly as non-union or some degree of spinal deformity may be clinically well tolerated. Surgical treatment may provide benefit in the presence of persistent cord compression or spinal instability in patients that can tolerate the procedure. Ultimately, treatment should be tailored individually. Prevention of these injuries should be the focus in a world population with an ever-increasing proportion of elderly people.