Skeletal system metastases are the third most common metastases, behind those of the pulmonary and hepatic systems. Patholgy, prognosis and management strategies are discussed in this chapter. Metastatic spine tumors are the most common spine tumors. Thoracic spine is most often involved. Single level is more common. Body is involved in most; intervertebral space are spared in spinal metastasis. Patients with a known highly radiosensitive lesion are better served by undergoing primary spinal irradiation. Surgical indications include the need to establish a diagnosis, spinal instability and epidural cord compression. Surgical decompression cannot reverse a complete paralysis of greater than 24 hours duration; pretreatment neurological status, duration of symptoms, location of the lesion, and status of the primary lesion and above all histology of the metastatic lesion determine the ultimate prognosis. Evolution of spinal stabilization apparatus and techniques, has greatly improved the efficacy of surgical intervention.