Malignant spinal-cord compression (MSCC) is a common complication of cancer and has a substantial negative effect on quality of life and survival. Despite widespread availability of good diagnostic technology, studies indicate that most patients are diagnosed only after they become unable to walk. We review the epidemiology, pathophysiology, and clinical features of MSCC. Clinical trials have informed the optimum management of MSCC, and we review the role of corticosteroids, radiotherapy, and surgery in the management of patients. We also emphasise advances in radiation delivery and the results of a randomised trial that supported aggressive debulking in patients with MSCC.