Abstract Primary tumors originating from the spine are very complex and challenging entities to treat. Due to their rarity, a multicenter collaborative network is essential to shepherd the best research and contribute to the dissemination of the best evidence possible. Over the last few years, several advances have occurred in many different fields. Surgery is still the cornerstone of treatment in most cases. The occasional suboptimal outcomes and high morbidity of surgical treatment have however encouraged professionals caring for these patients to explore safer treatment options and alternatives or adjuncts to surgical treatment. A number of novel treatment strategies have emerged from the medical, interventional radiology, radiation oncology, and molecular worlds. This has truly positioned primary spine tumors at the forefront of multidisciplinary care. This article discusses these recent advances in detail to equip the oncologic spine surgeon and their team to better counsel and treat these patients. Most of these advances allow for a more tailored, efficient, and, most importantly, less morbid management of primary spine tumors. Some of these advances are still under investigation, however, and evidence-based oncological principles should still be strongly encouraged.