Multiple sclerosis (MS) and cervical spondylosis are relatively common diseases. It is therefore inevitable that the MS clinician will be confronted with patients with myelopathy in whom the two conditions coexist. When faced with an MS patient who has cord compression secondary to cervical spondylosis as well as cord demyelination, the issue of surgical decompression of the cord arises. Whether the trauma of cord compression aggravates the MS lesions is still a matter of debate and should not influence treatment decisions. There is little prospective evidence-based support for the notion of surgical cord decompression in cervical spondylosis without MS, and none at all for surgery in MS, with only small published retrospective series available. The clinician must therefore make a judgment-based treatment decision. Guidelines for the management of patients with coincidental cervical cord compression and MS are suggested.