Spinal tumors account for approximately 6-10% of all bone tumors in the body. Almost all types of bone tumors can be seen in the spine, such as osteosarcoma, osteoid osteoma, and aneurysmal bone cysts, while metastatic bone tumors account for more than half of spinal tumors. Early diagnosis of spinal tumors is important because the functional outcome is dependent on the neurological status at the time of presentation. Spinal metastases themselves are often asymptomatic and are often detected only on routine bone scans. Symptoms may result from one or more of the following: (1) intrusion of a progressively larger mass within the vertebral body into the paravertebral soft tissues through the bone cortex; (2) compression or invasion of adjacent nerve roots; (3) pathologic fracture secondary to vertebral body destruction; (4) spinal instability following pathologic fracture, especially when complicated by osteolytic destruction of the posterior appendage; and (5) spinal cord compression. Spinal cord compression has been reported to occur in approximately 5% of patients with extensive metastatic cancer. Metastatic tumor foci infiltrate the vertebral body and reduce its strength, resulting in partial collapse of the vertebral body and subsequent invasion of tumor tissue or bone fragments into the spinal canal, which is the most common cause of spinal cord or nerve root compression. Back pain is the most common symptom in patients with spinal metastases, often preceding other neurological symptoms by weeks or months. Two different types of back pain can be seen: tumor-related pain and mechanical pain. Tumor-related pain is primarily nocturnal or early morning pain and is usually relieved by activity during the day. This pain may be due to inflammatory mediators or tumor strain on the periosteum of the vertebral body. Definitive treatment of the tumor with radiation therapy or surgery may relieve this pain. Recurrence of pain after treatment is indicative of local recurrence of the tumor. Mechanical pain arises from structural abnormalities of the spine, such as pathological compression fractures that lead to instability of the spine. This pain is motion-related, and is exacerbated by increased longitudinal load on the spine in a sitting or standing position. In addition, if a patient has a thoracic or thoracolumbar compression fracture resulting in a posterior protrusion deformity, the pain is severe in the prone position, and the patient often has a history of sleeping in a sitting position. Hormonal therapy is ineffective for mechanical pain, and pain can be relieved with narcotic analgesics or external bracing. Pain from pathologic compression fractures of the thoracic spine usually lasts for several days, but if the tumor does not invade the posterior adnexa, the pain usually resolves after several days. Currently, the treatment of spinal tumors generally requires a definitive diagnosis through biopsy. The principles of treatment for primary spinal tumors are the same as those for limb tumors. There are three main approaches to the treatment of spinal metastases: chemotherapy, radiation therapy and surgery. The goal of both medical and surgical treatment of metastases is to maximize the quality of life. Once the diagnosis of metastases is established, the role of surgery or surgery in combination with other treatments is to relieve pain, improve or maintain neurological function, and restore the structural integrity of the spine.