Epidural metastases are a common complication of malignancy and are usually considered an oncologic emergency requiring hospitalization and urgent diagnostic and therapeutic interventions. However, patients at high risk for epidural cord compressions can be identified, evaluated, and treated electively before they develop serious neurological deficits. Often this can be accomplished entirely in the outpatient setting. The early diagnosis and treatment of epidural metastases is crucial in preserving ambulation and bowel and bladder function. The possibility of such metastases should be suspected in any cancer patient with back pain.