Metastatic disease of the spine is a common presentation of patients with cancer. The management of spinal metastases is quickly evolving as medical therapies improve survival of many cancers and new technologies and techniques are developed in the fields of radiation oncology and spinal surgery. Familiarity with the treatment options and indications for surgery is paramount for spine surgeons, as the number of patients with cancer continues to increase with an aging population and improved survival of many cancers. The development of treatment algorithms to select optimal treatment strategies based on patient and tumor characteristics has emphasized the multidisciplinary input needed in treatment planning for these patients. The surgical management of metastatic disease continues to expand as new technologies and surgical methods are developed. Here we describe the surgical management of metastatic disease to the spine with an emphasis on indication and patient selection.