Extradural spinal cord compression (ESCC) as a consequence of metastasis from various primary cancers represents the most common type of malignant lesion affecting the spinal cord. It has been estimated that 5% of all patients with systemic cancer who are autopsied have pathologic evidence of tumor invading the extradural space. The incidence of ESCC is expected to increase due to improved survival of the cancer patient. The current approach to the diagnosis of ESCC depends upon the recognition of early symptoms and signs of spinal cord compression. Despite the increasing clinical awareness of these complications, irreversible loss of ambulation continues to occur in over half of these patients. Early diagnosis is critical since onset of spinal cord injury may be sudden, often progressing to irreversible paralysis in a period of hours. Consequently, physicians dealing with cancer patients must maintain a high index of suspicion. This paper analyzes prognostic factors based on our prospective study and emphasize the use of diagnostic tests in early recognition of ESCC before onset of neurologic deficits.