The aim of this multicenter, matched- pair study was to compare the outcome of stereotactic radiosurgery (SRS) with that of external radiation therapy (RT) when used as a primary treatment in spine metastasis from renal cell carcinoma (RCC). From 2005 to 2012, 13 patients underwent SRS as a primary treatment in spine metastasis from RCC. Thirteen patients who underwent RT as the primary treatment of RCC spine metastasis were paired with the SRS patients based on age, number of spine metastasis, time interval from original tumor diagnosis to spine metastasis, Eastern Cooperative Oncology Group status, and year of treatment. The primary outcomes of interest were pain relief and progression free survival. Secondary outcomes were treatment toxicities and need for further treatment. The perioperative VAS score decrease was larger in the SRS group than that in the RT group (P = 0.04). More SRS patients had complete or partial pain relief although the difference was not significant. There was a significant difference in progression free survival between the two groups (P = 0.01). The percentage of patients with toxicities was 38.5 % (5/13) in the SRS group and 53.9 % (7/13) in the RT group, but the difference was not significant. There were 2 SRS patients and 3 RT patients who received further intervention at the index segment. This study showed that, when performed as a primary treatment in spine metastasis from RCC, SRS provides relatively better pain relief and better local control than that obtained from RT.