For patients with spinal cord compression, from metastasis in the patient presented in this chapter, there is an immediate urgency to prevent permanent paralysis. For many physicians this is one of the most uncomfortable situations. The medical treatment with corticosteroids and indications for acute neurosurgical decompression are discussed in this chapter. Aggressive pain management with opioids and corticosteroids may provide adequate palliation. The treatment modality that is best for the patient is determined on the basis of severity and acuity of the neurological deficit, nature of the tumor, instability of the spine, and general performance status and life expectancy of the patient.