The recent technological advancements in imaging, treatment planning, image-guided treatment delivery, and motion management have enabled the wide adoption of stereotactic body radiation therapy (SBRT) in the management of spine tumors. Spine SBRT presents unique challenges due to the location of the target and requires careful considerations in every step of the treatment planning and delivery process to ensure safety and efficacy. In this chapter, we seek to review the physical and clinical aspects of spine SBRT with an emphasis on our institution’s approach.