Metastatic spinal cord compression is defined radiographically as an epidural metastatic lesion causing true displacement of the spinal cord from its normal position in the spinal canal.1 It is an important source of morbidity (including paralysis and bowel and bladder disorders) in patients with systemic cancer. #### Case scenario A 58 year old woman presents to her general practitioner with a two month history of middle to low back pain. She has a history of breast carcinoma, diagnosed eight years previously and which was treated with a mastectomy and chemotherapy. She also describes pins and needles in both legs for the past three days. On examination, she has tenderness over the area of the T11 and T12 vertebrae and reduced power distally (T4 and T5) but intact bowel and bladder function. She is referred urgently to the metastatic cord compression coordinator, who organises magnetic resonance imaging, which shows cord compression by a mass at the T11 and T12 levels, thought to be caused by metastases. #### How common is metastatic spinal cord compression? Low back pain is one of the most common complaints in primary care, with most cases being benign, self limiting, and not needing a specific diagnosis. The challenge in primary care is therefore to identify those cases where low back pain is caused by a serious spinal disease, such as malignancy. …