Spinal metastases are the most common tumors of the axial spine. Symptomatic spinal metastases in children and adults differ in a number of respects including culpable primary tumors, the degree of spinal column involvement, surgical strategies, and results of treatment. Magnetic resonance imaging has become the imaging method of choice for spinal tumors. The management of symptomatic spinal metastases is undertaken to relieve pain and to preserve or restore neurologic function. Radiation therapy is generally regarded as the initial treatment of choice. However, there has been a steady evolution in concepts and execution of surgical strategies for spinal secondaries. A prospective, randomized study should be undertaken to clarify the respective roles of therapeutic irradiation and surgery for metastatic tumors of the axial spine.