Background Data: Management of cervical spine fractures has no individualized treatment protocol. Most guidelines are based on the fracture types; our study, being done in a developing nation, has taken into consideration the socioeconomic factors and their implication in making a final treatment plan. Purpose: To compare socioeconomic and functional outcomes of surgical and nonsurgical management of acute cervical spine fractures with severe (ASIA-A and ASIA-B) neurological deficit at a minimum of 12 months postinjury. Study Design: A retrospective observational study. Patients and Methods: The study included a total of 42 patients: 22 were treated operatively (group A) and 20 treated conservatively (group B). Functional outcomes were assessed at a minimum of 12 months postinjury using the SCIM scoring scale. Other parameters, including the number of hospital days, total expenditure at discharge, ICU-related events, deaths within one year, and rehabilitation details, were analyzed. Results: The mean hospital stay in group A was 26 days, with one patient requiring ICU admission with an expenditure of $2707, whereas in group B, the mean days of hospital admission was 40 days with two patients requiring ICU admission incurring an expenditure of $850. ICU-related comorbidities were high in group A. One patient in group A and five in group B died within the first 12 months. Overall mortality within the twelve months following ASIA-A and ASIA-B cervical spine injury was 16.6%, with higher mortality in group B during the early (0–3 months) period. The mean SCIM functional score at 12 months in group A and B was 36.5 and 41.6, respectively (p =  0.2). No statistically significant difference was found in the functional outcome between survivors in both groups at 12 months. Conclusion: One-year survival was better in surgically treated patients with no difference (p = 0.09) in the functional outcome of both groups. Only an early and sustained rehabilitation in both groups help improving their quality of life. (2021ESJ247)