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Suspected malignant spinal cord compression (MSCC) is an oncologic emergency. Prompt initiation of high-dose corticosteroids (e.g., dexamethasone 10 mg IV bolus followed by 4–6 mg IV/PO every 6 hours) reduces vasogenic edema and may preserve neurologic function. Emergent MRI of the entire spine is essential to localize the lesion(s); plain radiographs are insensitive. Early multidisciplinary coordination with neurosurgery and radiation oncology determines definitive management—surgical decompression with stabilization offers the best chance of ambulation in selected patients (particularly with single-level disease, radiosensitive or radioresistant histologies, and acceptable performance status), while urgent external beam radiation therapy is preferred for nonoperative candidates or radiosensitive disease. Delay in imaging and treatment (Option A) risks irreversible deficits. Low-dose oral prednisone (Option C) is inadequate. Antibiotics (Option D) are not indicated unless there is evidence of infectious epidural abscess. Bladder catheterization, VTE prophylaxis, and analgesia are supportive priorities while definitive therapy proceeds.