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Spinal metastatis is a diagnostic and treatment challenge for the spine surgeon and must be addressed through multidisciplinary, multimodal, and individualized management. The presence of tumor cells in bone metastases results in homeostatic disruption between bone formation and remodeling and leads to osteolytic, osteoblastic, or mixed bone lesions. Spinal metastases are a significant cause for morbidity characterized by severe pain, impaired mobility, pathological fractures, spinal instability, and neurological involvement. Radiographs, magnetic resonance imaging, computed tomography, and positron emission tomography are widely used for the detection and staging of the disease. Histopathological examination is crucial to establish an oncological diagnosis. Our review focuses on epidemiology, pathogenesis, clinical presentation, and diagnosis of spinal metastasis.