The increasing life span of cancer patients has led to a rising incidence of bone metastases, with the spine being the most commonly affected site. Spinal metastases primarly arise from breast, lung, prostate, and kidney cancers. A multidisciplinary approach is crucial for the management of metastatic spinal cord tumors. Treatment options include surgery, radiotherapy, chemotherapy, immunotherapy, targeted agents, and pain management. The primary goal of systemic therapy is to improve the patient`s quality of life and survival. Treatment of metastatic spinal cord tumors is carefully tailored based on the tumor`s histology, size, location, and the patient`s individual characteristics. Systemic therapy selection is generally guided by the type and aggressiveness of the primary tumor. Corticosteroids are routinely administered as the first-line therapy for patients presenting with cord compression. Systemic chemotherapy plays a limited role in metastatic spinal tumors, except for chemotherapy-sensitive tumors such as lymphoma, small cell lung cancer, and germ cell tumors. In these cases, effective agents targeting the primary tumor are employed. A better understanding of the molecular pathways driving malignancy has led to the development of agents targeting specific molecular pathways and immunotherapy. Patients harboring tumor driver mutations now also have mutation-specific inhibitors as the preferred initial approach. A treatment duration of at least 6 months is generally recommended.Randomized controlled trials have demonstrated that these agents achieve longer disease control compared to cytotoxic chemotherapy. Additionally, zoledronic acid and denosumab are used in the management of bone metastatic cancer to prevent and delay skeletal-related events in addition to primary tumor-directed therapies.