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Delayed or inadequately treated spinal emergencies have a devastating impact on the long-term neurological function of the patient. All clinicians should therefore be aware of the cardinal symptoms and signs of spinal compression, to enable prompt diagnosis and treatment. The aim is to reverse or prevent further neurological deficit. Compression of the spinal cord or nerve roots may be due to disc herniation, trauma, tumours and infection.The key to diagnosis is clinical evaluation in combination with radiological imaging. Treatment is directed to the urgent surgical decompression of neural elements, prevention of secondary cord damage, prevention of complications, and supportive measures, providing an environment conducive to complete or partial neurological recovery. Patients should be urgently transferred to regional spinal centres for definitive treatment and rehabilitation.Guidelines have been published by the British Orthopaedic Association on the initial care and transfer of patients with spinal cord injuries, and by the National Institute for Health and Clinical Excellence on the diagnosis and management of metastatic spinal cord compression. These guidelines are summarized in this paper.