Compression of cervical spinal cord secondary to cervical spondylosis or disc herniation can result in acute or chronic myelopathy. This may go unnoticed in patients with multiple sclerosis who frequently present with similar symptoms. A high index of suspicion, recognition of differences in clinical features, and appropriate use of neuroimaging studies assist in the differentiation of these two disorders. Decompression surgery in carefully selected MS patients who have coexistent spinal cord compression is well tolerated and may result in an excellent outcome.