Patients with SCC due to metastatic disease of the spine must be simultaneously evaluated with regard to neurologic impairment, stability of the spine, and tumor type. A multidisciplinary approach is required for these patients including an internist, medical oncologist, radiation oncologist, and spinal surgeon. Compressive tumor extension can be treated effectively by radiotherapy for lesions that are radiosensitive, but radiotherapy cannot reverse a neurologic deficit if the SCC is a result of instability, vertebral collapse, or kyphosis. Spinal lesions with impending instability or current instability require spinal stabilization. The goals of surgery are to maintain or restore neurologic function and spinal stability, relieve pain, and maintain an independent quality of life. If the patient is medically able to undergo spinal surgery and has a life expectancy of 3 months or more, surgical intervention should be strongly considered.