Background. Zoledronic acid was demonstrated to reduce the rate of skeletal-related events, a hypernym including various outcomes, in patients with bone metastases. In contrast to other studies, this matched-pair analysis focused solely on the impact of zoledronic acid on metastatic spinal cord compression (MSCC).Patients and methods. Data from 98 patients with MSCC receiving radiotherapy plus zoledronic acid were matched 1:2 to 196 patients receiving radiotherapy alone for ten potential prognostic factors. Both groups were compared for local control of MSCC within the irradiated region, overall control of MSCC (local and distant MSCC control), and survival.Results. The 1-year local control rates were 90% after radiotherapy plus zoledronic acid and 81%, after radiotherapy alone (p=0.042). The 1-year overall control rates were 87% and 75%, respectively (p =0.016), and the 1-year survival rates were 60% and 52%, respectively (p=0.17). Results were significant in the Cox proportional hazards model regarding local control (p=0.024) and overall control (p =0.008).Conclusion. According to the results of this study, zoledronic acid was associated with improved control of MSCC in irradiated patients.