Epidural spinal cord compression (ESCC) is a common metastatic complication occurring in 5% of patients with cancer. We sought to determine retrospectively the frequency of multiple sites of ESCC at presentation and the risk of recurrence of ESCC. Of the cancer patients seen by the University of California San Diego's Neuro-Oncology Service between August 1986 and January 1997, 108 developed ESCC that was documented both clinically and by MRI of the spine. In 77 patients (71%), a single site of ESCC was seen; 31 patients (29%) had multiple sites of ESCC. All sites of ESCC were irradiated. In 7% of patients with single-site ESCC and in 9% of patients with multiple-site ESCC, the disease recurred. Length of survival was similar for patients with single- or multiple-site ESCC (median, 4.5 months) versus patients with recurrent ESCC (median, 7 months). An MRI of the entire spine in patients with suspected ESCC demonstrated multiple sites of ESCC in nearly one-third of patients. In 8% of patients with ESCC, symptomatic ESCC recurred.