A retrospective review of 160 cases of penetrating spinal injury (PSI) was undertaken to assess the benefits and risks of operative treatment. Criteria for operation included incomplete deficits, worsening neurological status, and associated visceral perforation. Of the 160 cases, 142 had gunshot wounds (GSW) and 18 had stab wounds (SW). Laminectomy, with or without intradural exploration, was undertaken in 23% of cases. No significant differences in outcome were found between the surgical and nonsurgical groups. Meningitis, CSF leakage, and wound infections were complications that occurred more often in the surgically treated group (22%) than the conservatively managed group (7%). It has not been possible to demonstrate a benefit of surgery in PSI in this retrospective study. A prospective study is proposed that would allow better control of the variables affecting outcome.