Recent advancements in imaging technology have made it possible to deliver very precise radiotherapy. By imaging the patient at the time of actual treatment, immediate corrections in patient positioning and set-up errors have become possible. Reduction in these types of treatment errors has had a significant impact upon the radiotherapeutic management of spine tumors because doses of radiation that exceed spinal cord tolerance can now be given within very close proximity to the cord. Also, the normal tissue margin around the target volume can be reduced, resulting in less of the dose being delivered to nearby critical organs. These factors have combined to improve patient outcomes, both in terms of tumor control and lower toxicity. The recent medical literature has reflected a growing interest in the application of image-guided technology to the treatment of paraspinal tumors. This review summarizes the significant contributions to the medical literature over the past calendar year.