The geriatric population is generally more prone to sustain musculoskeletal injuries, in particular in the setting of low-energy trauma. This is partly due to a combination of factors that include physiological and biomechanical changes that occur as we age, leading to reduced structural support, with increased risk of injury from minor trauma—particularly falls. Computed tomography (CT) is generally the preferred and most effective imaging modality to screen and rule out spine injury. Magnetic resonance imaging (MRI) is reserved for obtunded patients or for patients with suspected cord and/or ligamentous injury. Elderly patients with spine trauma may develop central cord syndrome secondary to cord injury, odontoid fractures, or cervical extension-distraction injuries. Nontraumatic spinal compression injuries in the geriatric population are mainly caused by degenerative disease, followed by tumors and infection. Given the continuous advancements in cancer treatment leading to longer life expectancy for cancer patients, the number of elderly patients experiencing malignant cord compression has increased. This is usually secondary to pathological vertebral body compression fracture with retropulsion into the spinal canal and/or to epidural tumor extension. In such cases, the radiology report should focus on the spinal instability neoplastic score and on the epidural spinal cord compression scale.