Important improvement of function can be gained by surgical treatment. However, the complication rate is high and many patients die of their disease within the first months of surgery. The indication for surgical treatment in spinal metastases at our institution has been neurological deficit due to epidural compression. In my view, other modalities such as radiotherapy and advanced pain management will relieve pain in the vast majority of patients, and I have not considered pain as a sole indication for surgery. Furthermore, all surgery for metastatic disease is palliative and will not significantly influence survival. Therefore, attempts at marginal or wide excision in solitary metastases of e. g. breast cancer as meaningless. Intralesional excision and reconstruction with cement, is however, often indicated to relieve spinal cord compression and restore spinal stability.