Two cases of spinal paragonimiasis are reported and 25 cases in the available literature are reviewed. In spinal paragonimiasis, an extradural lesion in the lower thoracic area is most common, giving rise to a spastic paraplegia. The paragonimus cysts and granulomas tend to form a long chain occurring over several vertebral segments. The mode of entry of the parasite into the spinal canal is discussed. Since the affection in the great majority of cases is extradural and localized in the thoracic part of the spine, it is suggested that the usual mode of invasion is probably a direct migration of the larvae from the lung. Five cases, however, were associated with cerebral paragonimiasis and had showed intradural spinal lesions. In these cases a direct spread from the brain through the subarachnoid space is considered most likely. The difficulty of differential diagnosis from spinal tumor is discussed. It is stressed that a spinal block associated with pulmonary or cerebral paragonimiasis, increased γ-globulin in the serum and a pleocytosis in the spinal fluid with predominance of lymphocytes are highly suggestive of a spinal paragonimiasis. The significance of a search for eosinophils in the spinal fluid is also stressed. Irregularly-serrated filling defects along several segments below or above a block found on myelographic examination is diagnostic and is a result of the chain of cysts or granulomas. The surgical and medical aspects of treatment are discussed, and it is suggested that surgery should always be supplemented with Bithionol treatment in order to prevent recurrence.