Malignant epidural spinal cord compression (MESCC) is a common neurologic complication of cancer. MESCC is a medical emergency that needs rapid diagnosis and treatment to prevent undergo emergent evaluation including magnetic resonance imaging of the entire spine. If MESCC is diagnosed, corticosteroids should be administered. Simultaneously, spine surgery and oncology teams should be immediately consulted. If indicated, patients should undergo maximal tumor resection and stabilization, followed by postoperative radiotherapy. Emerging treatment options such as stereotactic radiosurgery and vertebroplasty may be able to provide some symptomatic relief for patients who are not surgical candidates.