BACKGROUND. The current study was performed to create a scoring system to estimate the survival of patients with metastatic spinal cord compression (MSCC). METHODS. Based on a multivariate survival analysis of 1852 patients who were treated with radiotherapy (RT) for MSCC, a scoring system was developed. The system included the 6 prognostic factors found to be significant in that multivariate analysis: tumor type, interval between tumor diagnosis and MSCC, other bone or visceral metastases at the time of RT, ambulatory status, and duration of motor deficits. The score for each prognostic factor was determined by dividing the 6-month survival rate (given as the percentage) by 10. The total score represented the sum of the scores for each prognostic factor. Total scores ranged between 20 and 45 points and patients were divided into 5 groups. For each group, the survival was compared for short-course or long-course RT. RESULTS. The 6-month survival rates were 4% for patients with a score of 20 to 25 points,11% for patients with a score of 26 to 30 points, 48% for patients with a score of 31 to 35 points, 87% for patients with a score of 36 to 40 points, and 99% for patients with a score of 41 to 45 points (P < .001). Patients with scores ≥36 were found to have a significantly longer survival when comparing long-course versus short-course RT, and those with scores <36 were found to have similar survival regardless of whether short-course or long-course RT was used. CONCLUSIONS. Using the scoring system described herein, patients with MSCC can be grouped to estimate survival. Patients with scores ≥36 were found to survive longer with long-course RT, whereas patients with lower scores had a similar survival regardless of whether long-course or short-course RT was used.