Spinal metastatic disease and spinal cord compression are major causes of morbidity and mortality in cancer patients. Treatment of metastatic disease of the spine frequently requires surgical decompression, reconstruction, and stabilization in addition to radiation and chemotherapy. Instability of the spinal column has been recognized as a significant cause of pain in cancer patients. During the past decade, various innovative surgical approaches and new methods of spinal instrumentation have been developed. Recent advances now enable the surgeon to achieve more radical resections of these neoplasms and to reconstruct and stabilize the spine more effectively. Surgeons dealing with the treatment of these patients should not only be familiar with all surgical approaches to the spinal column but also be proficient in using various reconstructive instruments. This article provides an overall review of the literature during the past 2 years for physicians who participate in the treatment of these cancer patients.