Chordomas of the mobile spine are extremely rare but challenging primary tumors. Traditionally, en bloc excision has been promoted as the treatment of choice; however, wide or marginal margin curative excisions are often precluded by anatomic constraints such as the dura and spinal cord, further complicated by the ability to account for satellite or skip lesions, leading to high recurrence rates. Recent data suggests that proton beam, carbon-ion and photon-beam-based stereotactic radiosurgery can deliver ablative radiation doses to chordoma even when used as definitive treatment or in conjunction with limited surgery. The integration of advanced radiation techniques is being integrated into treatment paradigms as definitive, postoperative or neoadjuvant treatment and is demonstrating improved local tumor control with reduced morbidity compared to en bloc resection alone. Additionally, promising targeted systemic agents are currently in clinical trials. This chapter provides treatment recommendations based on current outcomes data of both surgery and radiation for mobile spine chordoma.