The management of bone metastases has changed considerably over the past decade, with the improved longevity of cancer patients, the advent of bisphosphonates, and the availability of other new treatment modalities. Of primary importance is the systematic establishment of the diagnosis of metastasis before treatment, which avoids improper management of primary bone malignancies and optimizes oncologic treatment. The decision to use surgical stabilization rests not only on structural concerns but also on the patient's anticipated longevity, activity goals, and preferences. Minimally invasive options are available to treat bone lesions in areas not amenable to surgical stabilization or in patients who are poor candidates for surgery. Selected patients with spinal metastases, especially those with cord compression, may benefit from decompression and/or stabilization.