Most patients with paralysis of the legs due to neoplastic compression of the spinal cord have a favorable outlook. Certain factors indicate a poor prognosis: (1) rapid onset; (2) prolonged paralysis; (3) flaccid paraplegia; (4) paraplegia due to malignant disease; and (5) paralysis associated with vertebral collapse. With early accurate diagnosis, prompt laminectomy and decompression of the spinal cord, and such adjunct therapy as is indicated, the outlook can be improved for many patients. Rapidly developing paraplegia due to neoplastic compression is a neurosurgical emergency. Patients with paraplegia of 2 months or even 18 months duration may recover after surgical decompression. Flaccid paraplegia, although very serious, is not necessarily hopeless. Primary intraspinal lymphosarcoma often has a favorable outlook. Giant-cell tumor of the spine is not malignant and can be cured by surgical decompression and x-ray therapy.