Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. The treatment paradigm for spinal metastases involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient's overall condition. There have been significant advances in the surgical treatment of spinal metastases that can significantly improve a patient's quality of life. demonstrated that vertebral metastases are found in as many as 30% of patients with malignancies. 2 Spinal metastases are most commonly seen, in decreasing order of incidence, from primary lung, prostate, kidney, liver, gastric, and colon cancers in males and primary breast, lung, uterine, thyroid, and gastric cancers in females. 3 In addition, there is a significant contribution from hematogenous disorders such as lymphoma and multiple myeloma. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. 4 Magnetic resonance imaging is the diagnostic modality of choice in the diagnosis of spinal metastases, with a sensitivity of 93% and a specificity of 97%. 5 Additional information regarding the extent of bone destruction and alignment can be obtained with computed tomography of the spine.We have found that a cohesive multidisciplinary approach to the treatment of metastases to the spine can improve outcomes as it brings the treating physicians together and allows plans to be made in the context of the patient's overall condition. The initial evaluation should involve a thorough history, including any prior history of malignancy. In some cases, symptoms related to spinal metastases are the first signs of malignancy, and a thorough metastatic workup, including standard X-rays, computed tomography of the chest, abdomen, and pelvis, positron emission tomography, and bone scans, is often necessary to identify the primary tumor. In addition, blood dyscrasias such as multiple myeloma and lymphoma need to be considered, and this requires further laboratory studies of the blood and possibly cerebrospinal fluid. Treatment paradigms involve close collaboration between the medical oncologist, radiation oncologist, and spine surgeon. The pathology of the primary tumor is important in determining the patient's life expectancy, sensitivity to adjuvant treatments, and likelihood of achieving systemic control.