The management of patients with metastatic disease of the thoracolumbar spine should be highly individualized and depends on several factors, including the clinical presentation, duration of symptoms, tumor type, anticipated radio-sensitivity, tumor location, extent of extraspinal disease, integrity of the spinal column, and medical fitness and life expectancy of the patient. Although no single approach is always applicable, anterior approaches provide several advantages, including minimal removal of uninvolved bone, rapid extirpation of the tumor, improved hemostasis, effective reconstruction of the weight-bearing anterior column, short-segment fixation,and improved wound healing. Wider acceptance and judicious use of current surgical techniques for metastatic spine disease may improve the quality of life of patients too often denied such treatment.