Malignant spinal cord compression can lead to permanent neurological dysfunction and is therefore considered an oncological emergency. It is mostly caused by metastases to the spinal column, most frequently from breast, prostate and lung cancer, multiple myeloma and lymphoma. Clinically, it presents with pain, muscle weakness and autonomic dysfunction. The diagnostic method of choice is magnetic resonance imaging or computed tomography-myelography in the case of contraindications. To preserve the neurological functions, diagnostic and treatment measures should be started as soon as possible (within the first 48 hours) after initial presentation. Therapy starts with corticosteroid and continues with surgical and radiation methods, rarely with systemic therapy. Decision on the best modality of treatment is individualized, depending on the type and extent of the malignancy, the presence of potential spinal instability, the patients’ condition and their wishes. Surgical decompression is the treatment of choice for patients with spinal instability, as well as for radioresistant masses. Radiation therapy is mostly applied postoperatively or used on its own for patients with contraindications for the surgical procedure or with highly radiosensitive tumors. Lately, even in the case of radioresistant solitary spinal metastases, stereotactic radiation is being used as an alternative approach to surgery. With this technique, high radiation doses can be applied to the malignant tissue with little damage to surrounding area.