Spinal cord compression (SCC) occurs when degenerative spine disease, metastatic or primary spine tumors, hematoma, infectious lesions, or other etiologies pressurize the epi- or intradural space and therefore the spinal cord. The exact incidence and prevalence of SCC remain unknown. Neck or back pain is a common symptom of the clinical presentation. Radicular pain and symptoms of spinal cord dysfunction such as weakness, sensory disturbances, and bowel and bladder dysfunction typically follow. For diagnosis magnetic resonance imaging (MRI) is the method of choice. MRI visualizes the structures around the spinal column and the intrinsic aspects of the cord adjacent to the lesion. In certain conditions like neoplasms, computed tomography (CT) is necessary to assess osteolytic destruction, which may cause instability of the spine. The clinical diagnosis of acute SCC without delay is critical because patient outcome heavily depends on timely decompression strategies. Neurological function at the time of treatment is an important outcome predictor, and, if diagnosis is missed, patients may have further neurological deterioration. Treatment principles for patients with SCC should aim for improvement or preservation of neurological function keeping the patient’s underlying disease burden in mind. In patients with neoplastic SCC, surgery and radiation therapy are common therapeutic options. Systemic therapy may be beneficial in patients with chemosensitive malignant tumors. Evacuation of a hematoma by surgical decompression remains the treatment of choice in patients with a relevant neurological deficit. Antimicrobial therapy and surgical management are the treatment options of choice for empyema caused SCC.