Primary spinal tumours account for 10% of all central nervous system (CNS) tumours in children, half intramedullary and the other half extramedullary [1]. Extramedullary tumours include intradural extramedullary and extradural tumours. Extradural tumours include osseous lesions of the spine and paraspinal soft tissue lesions. Spinal osseous tumours can be primary osseous or metastatic from non-CNS primary neoplasms. The chapter systematically reviews the imaging features of primary spinal neoplasms (both benign and malignant), metastatic disease, and tumor mimics. A structured diagnostic approach is outlined, integrating clinical context, imaging findings, and key radiologic signs to guide effective patient management.