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Spinal cord compression in pediatric patients can occur due to tumors and is an oncologic emergency. It is imperative that the clinician be able to recognize the symptoms early to intervene and hopefully prevent long-term damage or irreversible loss of function. Pain is the earliest presenting symptom, followed by loss of motor function and bowel/bladder dysfunction. MRI with and without gadolinium is the imaging choice of modality and will further dictate treatment.