The goal of surgical treatment of metastatic spinal tumors is to maintain neurologic functioning without pain for the duration of the life expectancy. Of 28 patients in this series, 25 who had metastasis in the vertebral body underwent direct decompression by removal of the tumor, followed by vertebral reconstruction. A combined anterior or posterior instrumentation provided rigid spinal stability immediately after surgery. Three patients with involvement of the posterior part of the vertebra were treated by laminectomy for removal of the tumor, followed by posterior instrumentation. As a result, of nine patients who are alive with improved neurologic functions, seven have been ambulatory for an average duration of 13 months. Of 19 patients who have already died, recurrence of neurologic deficits was observed in five (26%), and 14 had no neurologic deterioration until they succumbed to the malignancy. Removal of the tumor and reconstructive surgery may be expected to produce satisfactory results