The existence of myelopathy as a complication of diabetes is debatable and, in the few reported cases, spinal involvement has been diffuse. We describe 2 cases of focal myelopathy. Two insulin-dependent, middle-aged men with adult-onset diabetes presented with gradually ascending lower limb pain and numbness without sphincteric symptoms. Examination showed mixed upper and lower motor signs in the lower limbs, with a severe impairment of cutaneous sensation below a sharply demarcated band at the T9-10 level with relative preservation of posterior column function. Myelography was normal. CSF showed mild elevation of protein and in one case showed 23 x 10(6) white cells/L. Nerve conduction studies showed a co-existing, mild sensorimotor neuropathy. There was no evidence of truncal radiculopathy on paraspinal EMG. Extensive investigation for other causes of myelopathy was negative.