This is an emergency that requires immediate diagnosis and treatment. Etiology is usually related to tumor (or trauma). Immediate imaging of the applicable spine segment (cervical, thoracic, or lumbar as determined by the neurological examination) by CT with and without IV contrast or MRI with and without IV contrast is indicated. MRI is usually preferred if available and the patient can tolerate the examination. Once the imaging has been completed the referring physician should be prepared for immediate consultation to the neurosurgery or radiation therapy (or both) services, depending on the etiology of spinal cord compression.