Metastatic spine tumors cause the loss of the supporting function of the spine through vertebral destruction or invade and compress the spinal cord or cauda equine. As a result, metastatic spine tumor causes severe pain, paralysis, or impairment of activities of daily living (ADL). Also, because the finding of metastatic foci in the spine suggests a generalized disorder, life expectancy and treatment options have many limitations. For this reason, treatment is primarily symptomatic, and the major goals in selecting therapeutic modalities are to relieve pain, prevent paralysis, and improve ADL. This article discusses the selection of treatment for metastatic spine tumors and, in particular, the indications for surgical treatment.