Stereotactic radiosurgery is a viable treatment option for spine lesions provided the lesion can be targeted precisely and radiation can be delivered while limiting dose to surrounding critical structures. We present our treatment experience with image-guided stereotactic radiosurgery with the CyberKnife for spine lesions. Thirty-four patients with 38 lesions were treated at Stanford University from July 1997 to July 2002. These lesions included primary tumors, metastatic tumors, and vascular malformations throughout the spinal axis. The inverse treatment planning system provided highly conformal dosimetry of prescribed doses ranging from 1,400 to 2,520 cGy delivered in one to five stages. Based on skeletal landmarks and implanted fiducial markers, true image-guided treatment was delivered in an outpatient setting. This technique has been used to treat patients with spine lesions that are otherwise untreatable with low associated morbidity. Longer follow-up in a larger series is needed to more adequately assess safety and efficacy; however, this technology is a promising addition to a neurosurgeon's armamentarium.