Acute myelopathy in a traumatic and nontraumatic setting is a medical emergency requiring urgent evaluation with spinal MRI. A compartmental approach to imaging, combined with clinical and laboratory findings, aids in localizing the lesion and refining the differential diagnosis. Compressive myelopathy, often managed surgically, must be distinguished from noncompressive causes, which have a wide range of etiologies. Familiarity with the MRI findings of various compressive and noncompressive myelopathies is essential for timely and accurate diagnosis, ultimately improving patient outcomes.