Symptomatic spinal metastases frequently complicate and often herald the diagnosis of cancer. Minimally invasive treatment options are particularly attractive in these patients as widespread malignant disease significantly increases the risks and potential complications of open spinal surgery. Moreover, recognizing the current incurable nature of most metastatic malignancies, treatments often remain palliative, and striving to reduce time spent in the hospital recovering from major open surgical interventions for cancer patients is a laudable goal. The predominant clinical picture of spinal metastases—isolated pain without spinal instability or neural element compression—has inspired new, minimalist approaches because medical management of this pain syndrome is often disappointing. The minimally invasive techniques of vertebroplasty, kyphoplasty, and radiosurgery are becoming increasingly important in the treatment paradigm of metastatic spinal tumors.