Back pain is a primary symptom of spinal cord compression in patients with known malignancy. Back pain may prompt a bone scan to confirm or exclude spinal metastasis. Rapid identification and intervention of metastatic spinal cord compression is necessary to preserve neurologic function. Causes The cause of the majority of spinal tumors is currently not known. Primary spinal tumors are associated with a few genetic syndromes. Neurofibromas are associated with neurofibromatosis 1 (NF1). Meningiomas and schwannomas are associated with neurofibromatosis 2 (NF2). Intramedullary hemangioblastomas can be seen in patients with von Hippel-Lindau disease. Spinal cord lymphomas are commonly seen in patients with suppressed immune systems. The majority of extradural tumors are due to metastasis, most commonly from breast, prostate, lung, and kidney cancer. Pathophysiology The spinal cord is a long, cylindrical anatomical structure that is located within the vertebral cavity. It runs from the foramen magnum of the skull to the conus medullaris at the lumbar spine. Most symptoms from spinal tumors occur due to compression of the spinal cord as it plays a primary role in motor and sensory function. The spinal cord is surrounded by three layers known as the spinal meninges. These are the dura mater, arachnoid mater, and pia mater. Spinal cord tumors are classified based on their location within the spinal cord: intradural (intradmedullary and extramedullary) and extradural tumors. Intradural tumors are located within the dura mater. These are further broken down into intramedullary and extramedullary tumors. Intradural-intramedullary tumors are located within the spinal cord itself, with the most common being ependymomas, astrocytomas, and hemangioblastomas. Intradural-extramedullary tumors are located within the dura but outside of the spinal cord parenchyma, with the most common being meningiomas and nerve sheath tumors (e.g. schwannomas, neurofibromas). Extradural tumors are located outside the dura mater most commonly in the vertebral bodies from metastatic disease. Common primary cancers in metastatic spinal tumors includes breast, prostate, lung, and kidney cancer. It is important to diagnose and promptly treat metastatic tumors as they can lead to long-term neurologic deficit from epidural spinal cord compression. Primary extradural tumors are rare and most arise from surrounding bony and soft tissue structures, including Ewing's sarcoma, osteosarcoma, and vertebral hemangioblastomas. Diagnosis Medical Examination The diagnosis of spinal tumors is challenging, as the symptoms can be non-specific and often mimic more common and benign degenerative spinal diseases. A comprehensive medical examination is necessary to look for signs or