Vertebral involvement is a common and often debilitating complication in patients with cancer, affecting up to 70% of those with advanced-stage disease. Vertebral metastases can result in severe pain, mechanical instability, pathological fractures, and reduced mobility, significantly impacting patients’ quality of life and limiting further oncologic treatments. In this context, image-guided percutaneous procedures such as vertebroplasty, kyphoplasty, and vertebral implant placement have emerged as effective, minimally invasive tools for pain relief and spinal stabilization. These procedures aim to restore structural integrity, alleviate pain, and—when feasible—reconstitute vertebral height. Careful patient selection, based on clinical and radiological criteria, is fundamental to ensuring success. The Spinal Instability Neoplastic Score (SINS) provides a standardized framework for assessing mechanical instability in the oncologic spine, guiding treatment decisions. This chapter provides a comprehensive overview of the indications, imaging work-up, technical aspects, outcomes, and complications of vertebroplasty, kyphoplasty, and vertebral implants, with a specific focus on their role in managing malignant vertebral disease. Additionally, emerging technologies and integration with ablative therapies are discussed. Illustrative clinical cases further support the practical application of these techniques.