The treatment of metastatic disease to the spine involves a comprehensive evaluation of the patient and an individualized treatment plan based on the tumor type and location, the extent of the disease, and the general medical condition of the patient. Careful consideration of these factors dictates the treatment options, which include surgery, radiation, chemotherapy, and/or palliative options. Patients with a good overall prognosis may be considered candidates for more aggressive surgical resections, such as en bloc resections, whereas those with a poor prognosis may benefit from less invasive piecemeal resections to decompress the spine and restore neurologic function while minimizing the morbidity associated with more invasive procedures. The goals of surgery are tailored to the overall prognosis and should be aimed at optimizing the quality of the patient's life.