(See Chap. 20. Spinal Cord Compression) Expansion of vertebral body metastasis posteriorly into epidural space compresses cord. Most common primary tumors are breast, lung, prostate, kidney, lymphoma, and myeloma. Back pain (>90%) precedes development of weakness, sensory level, or incontinence. Medical emergency; early recognition of impending spinal cord compression essential to avoid devastating sequelae. Diagnosis is by spine MRI.