The osseous spinal column is a frequent site for metastases of various malignant tumours from any part of the body. Neoplastic disease of the spine presents a complex problem of pain, spinal instability and neurologic complications. The general aims of treatment are to eliminate or reduce pain, to prevent or correct spinal instability and to prevent or reverse neurologic complications. Although surgery is now established as a viable, beneficial treatment option in the treatment of spinal metastases, controversy exists regarding the relative merits of surgery, radiotherapy, chemotherapy, and a combination of these therapies in different patients groups. Early detection and management of spine metastases is the ultimate goal for the neurosurgeon, other clinical colleagues should keep in mind that the challenge is to detect spine metastases as early as possible, not only in known cancer patients, but also in patients not known to have malignancies. Any delay in diagnosis and referral results in preventable deterioration in neurologic function.