Recent advances in molecular biology with the development of novel therapeutic agents, as well as fundamental understanding of the mechanisms of bone metastases have greatly altered the therapeutic options in patients with spine tumors. Improvements in spine instrumentation as well as the development of recombinant Bone Morphogenetic Protein for spine reconstruction and fusion offers promising hope for curative strategies in selected patients. A clearer application of the fundamentals of surgical oncology applied to spine tumors should result in a greater proportion of patients undergoing surgically appropriate en bloc resections for spine tumors. Finally, the superiority of surgery over external irradiation in the controlled clinical trial setting should greatly expand the pool of patients requiring surgery. In this review, we consider the recent advances in primary bone tumors including chordoma, sarcomas, multiple myeloma, as well as metastatic cancer to the spine.