Stereotactic body radiation therapy (SBRT) has emerged as a novel treatment modality for spinal metastases. Due to advances in radiation delivery technologies, it is now possible to deliver ablative doses to spinal metastases safely and effectively, and in particular high-dose re-irradiation. Data from the literature has demonstrated high rates of pain and local control with SBRT for spinal metastases, which is an active area of clinical investigation. Although there are potential therapeutic gains with spine SBRT, toxicities rarely seen with conventional radiotherapy, such as radiation-induced myelopathy and vertebral fractures, have been observed after SBRT in a small percentage of patients. Prospective clinical trials are required to define the role of SBRT in the management of spinal metastasis and to determine the appropriateness of using SBRT in various clinical settings. The purpose of this review is to provide an overview of the current state of spine SBRT practice.