Spinal cord compression should be considered in patients presenting with severe back pain and new-onset urinary retention with overflow incontinence.  Etiologies can include primary or metastatic tumor, herniated disc, epidural abscess, vascular malformations and vertebral burst fractures.  Pain is often at the level of the lesion and there may be tenderness to percussion at the affected level of the spine.  Signs include bilateral leg weakness and bilateral sensory deficits to pinprick that may suggest the cord level.  Muscle tone and reflexes may be diminished in acute lesions due to spinal shock.  In slowly progressive lesions, such as cancer, there should be spasticity, hyperreflexia, and upgoing Babinski’s.  Spinal cord compression is a neurosurgical emergency and immediate imaging with MRI is mandatory, and, if confirmed, high dose steroids with dexamethasone and radiotherapy begun if the treatment is found to be malignancy.  Fever should suggest infectious etiology.