Bone metastases account for 70-80% of all malignant bone lesions. The spine is the most common site of bone metastases. As the elderly population increases, diagnostic methods for tumors improve, and patients respond well to treatment with surgery, radiation therapy and chemotherapy, thus prolonging their survival, they are more likely to be affected by metastases. Spinal metastases are found in 40% of cancer patients. Spinal metastases can cause pain, neurological deficits and impaired quality of life. Recent advances in medical and radiation oncology, such as tumor genetics and stereotactic radiosurgery, are changing the approach to the treatment of metastatic spine. The most appropriate treatment consisting of chemotherapy, radiotherapy and surgery should be selected in a multidisciplinary approach for each patient with spinal metastases. Stereotactic radiosurgery combined with separation surgery is now more preferred.