This chapter focuses on primary spinal tumours, delving into their epidemiology, classification, and diagnostic imaging approaches. Recent advancements in imaging, such as high-resolution computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans, have revolutionised preoperative planning by precisely delineating tumour margins and their proximity to critical structures like the spinal cord and nerve roots. These imaging modalities, combined with standardised staging systems, facilitate personalised treatment strategies while improving oncological outcomes and reducing morbidity. Additionally, advanced imaging plays a key role in post-treatment surveillance, enabling early detection of recurrence and assessment of therapeutic response to adjuvant treatments like radiation or targeted biologics. This chapter will systematically examine different types of primary spinal tumours, their characteristic features, and common non-neoplastic mimics. Tumour staging, essential for prognosis and therapeutic decision-making, will also be discussed in detail. Furthermore, we will explore current treatment modalities, including surgical, radiological, and medical interventions, to provide a comprehensive understanding of spinal tumour management. While some overlap may occur with other chapters in this book, as certain tumours are discussed elsewhere, this chapter aims to consolidate essential knowledge for accurate diagnosis, staging, and optimised treatment planning in spinal neoplasms.