Myelopathy is a clinical diagnosis based on symptoms and physical examination findings. Laboratories and imaging, particularly with magnetic resonance imaging, can suggest a cause. Compressive myelopathy from degenerative disease of the vertebral column is the most common cause of myelopathy in older adults and should be screened for first in most cases. There are many other causes of myelopathy, including infectious, immune-mediated, nutritional, vascular, and neoplastic etiologies.