Early symptoms of spinal cord compression are back pain with or without a radicular component. Fast growth of tumor or abscess generally causes pain; slow growth causes weakness and other cord compressive signs. Hyperalgesia suggests nerve root involvement. In the evolution of symptoms and signs, motor loss occurs before sensory loss because of the anatomy of the tracts of the cord. Decreased strength results from compression of anterior horn cells. Posterior compression affects the posterior spinocerebellar and lateral spinothalamic tracts, manifesting as decreased posture appreciation, ipsilateral decreased vibration sensation, and contralateral decreased pain and temperature sensation. Incontinence occurs late in the course of cord compression, with urinary incontinence preceding rectal incontinence, and signifies that reversal of symptoms with therapy is unlikely.

If the cord compression is due to an epidural abscess, fever and obtundation are often present in addition to the neurologic deficits. When deterioration occurs rapidly, it is often secondary to the infection and inflammation causing venous thrombosis resulting in cord ischemia.

The level of cord involvement can be predicted from the level of vertebral involvement and vice versa. Analysis of dermatomes is commonly used to determine the level of cord involvement.