The most common type of spinal tumour is due to spread of a cancer from another part of the body (metastatic disease). Tumours arising from the spine itself are rare. Both forms of tumour cause spinal pain and if advanced, can lead to instability of the spine and pressure on the nerves and/or spinal cord. First line treatment involves cancer specialists and chemotherapy or radiation therapy. Only if pain is unrelieved or the spinal cord is threatened is surgery considered. The role of surgery in metastatic disease is to control the spinal tumour and prevent paralysis, but surgery cannot improve the overall prognosis. The role of the surgeon is as part of a team that includes radiation and medical cancer specialists.