Metastatic tumors that affect the spine often begin as a metastasis to bone, especially the pedicle. As they grow, they cause local pain. They then enlarge further and affect the exiting nerve root at that level resulting in a clinical radiculopathy. Only later do they grow and compress the spinal cord or cauda equina, depending on their location. Clinical signs of spinal cord compression typically appear acutely over hours to days. They are a neurological / neurosurgical emergency usually requiring a combination of high dose corticosteroids, radiation and surgical decompression.