Compression of the spinal cord may present to general physicians, orthopaedic surgeons, neurologists or, if radicular pain is mistaken for intra-abdominal pathology, general surgeons. The causes of spinal cord dysfunction are diverse and range from anterior spinal artery ischaemia through a range of inflammatory insults to structural compressive pathology. The purpose of this article is to discuss the diagnosis of spinal cord compression, how to localise it clinically and how best to manage it.