Pathologic fractures are common in patients with metastatic cancer involving the spine, yet many patients are highly frail and less than ideal surgical candidates. For these patients a number of minimally invasive interventions have been developed that can ameliorate mechanical pain and correct mild deformity. Many of these technologies have been borrowed from the osteoporosis literature, though indications are similar in the oncology population, chiefly mechanical back pain without complete vertebral column collapse. The oldest interventions—vertebroplasty and kyphoplasty—inject polymethylmethacrylate cement into the affected level, but new variations on these approaches supplement the cementoplasty technique with additional devices (e.g., OsseoFix®, SpineJack®, Kiva system) that may improve the load-bearing properties of the treated level. Additionally, such techniques can be combined with ablative interventions (e.g., radiofrequency ablation) designed to reduce tumor mass effect. This chapter highlights these technologies, their relative indications, and points for additional exploration.