Stereotactic radiotherapy has profoundly changed the management of spine metastases as a noninvasive, well-tolerated ablative therapy that provides high rates of durable tumor control for even radioresistant tumors. It utilizes radiobiologically potent high-dose per fraction treatment with high precision by marrying conformal intensity modulation treatment planning with 3D near-real-time image guidance, reducing uncertainties and minimizing dose to normal tissues and organs. It has found wide acceptance and utility in the stand-alone treatment of spine metastases, in the postoperative setting, and as salvage therapy for prior radiation failures. In the oligometastatic setting, it has demonstrated additional benefits in terms of reducing the risk of new distant disease and may prolong survival.