Bone metastases are common in the spine, often resulting in severe pain. Risk of the cord and roots compression is high. It has been proven that only early, prompt surgical treatment might prevent neurological deterioration. Even the first clinical symptoms are indication for immidiate surgery. Other urgent indications include: vertebral fracture, destruction of the posterior wall and pediculum. Operative treatment depends on the location of metastases. The anterior approach is always chosen in the cervical area. In the thoraco-lumbar segments selection of the approach is based on the localisation and morphology of the metastases. If the prognosis seems to be fair the anterior or posterior decompression alone might be sufficient. Breast cancer metastases should be resected from the anterior approach.