Study Objectives. The study was conducted to analyze and compare different types of surgical access in the treatment of patients with metastatic vertebral lesions to improve the outcome of surgery. Materials and Methods. The study included 108 patients with vertebral metastases who were operated on at the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine in 2015–2019. Results. The choice of surgical access depended on a few factors such as tumor location relative to the dura mater, bones, and nerve structures and was as follows: posterior access was used to resect tumors located posteriorly and posterolaterally to the brain; lateral access was used for tumors located laterally to the brain; anterior access was used to resect tumors located in front of the spinal cord. In Group I (73 patients), posterior access was used in 49 cases (67%), anterior access – in 19 cases (26%), and lateral access – in 5 cases (7%). In Group II (35 patients), only posterior access was used. Discussion. Selection of adequate surgical access for vertebral tumor resection in order to minimize nerve structure injury significantly improved the results of surgical treatment. Anterior and lateral access for ventral and ventrolateral tumors operation made it possible to completely resect the tumor, reduce the traction of nerve structures, and obtain sufficient visual control of the operating field during the surgery, which in turn had a positive effect on regression of pain and conduction disorders. Conclusions. A differential approach to the choice of surgical access reduces the neurological deficit in the postoperative period and allows radical resection of the tumor, which in turn helps to significantly reduce the number of tumor recurrences in the long-term period.