Sacral tumors are mainly metastatic in origin, while benign lesions are usually benign aggressive or low-grade malignancies. Symptoms of these lesions are non-specific and usually are diagnosed in advanced stages, causing major therapeutic difficulties that require a multidisciplinary approach. The most frequent malignant primary tumors of the sacrum, such as chordoma and chondrosarcoma, require special mention due to the complexity of their surgical management. Sacrectomy implies discontinuity between the mobile spine and fixed pelvis, in addition to important neurological sequelae mainly focused on rectal and bladder sphincter control. These are very complex procedures with a high incidence of serious perioperative complications. In general terms, sacral tumors, like the rest of the axial neoplasms, have a worse prognosis than their appendicular counterpart and must be managed in specialized centers and by highly trained specialized medical staff. The objective of the present review is to generate a concrete but current presentation paper on a group of skeletal neoplasms whose prognosis depends largely on rapid diagnosis and adequate treatment.