Disorders due to spinal cord compression or ischemic spinal cord lesions represent the most relevant nontraumatic spinal cord injuries causing acute para- and tetraplegia. In acute spinal cord compression early diagnosis is most reasonable to indicate early operative intervention with decompression to prevent progressive neurological deficits. In patients suffering from malignant disorders the indication for operation is directed to maintain quality of life in an appropriate level (pain treatment, mobility by wheelchair). In chronic spinal cord compression operations are aimed to prevent the development or progression of neurological deficits, as the outcome of rehabilitation is very much dependent to the neurogenic damage. In ischemic spinal cord lesion therapy is restricted to prevent further cadiovascular complications which additionally induce spinal cord dysfunction.