Tumors cells no longer confined to an affected organ can be released through lymph and the blood stream, disseminate and form metastases. Metastases to the spine are frequent, may be painful and may occur in an isolated or multiple level manner, they may lead to structural failure of the spinal column and cause com­ pression of nerve structures resulting in progressive paralysis or in painful radi­ culopathies. The dinical evaluation as weIl as to tumor pathophysiology are weIl explai­ ned in two general chapters and then each specific primary tumor is analyzed in a specific chapter. The choice was made to offer a multidisciplinary approach. One may thus find similar aspects repeated in different chapters, yet this is ne ces­ sary since each part of this textbook can be used as a specific reference. I was impressed by the carefully detailed humane approach to the patient information with care for the patient's dignity. Truthful information is explained dearly enough to give all the elements the patient needs to understand and accept neces­ sary treatments with a responsible attitude. Previously, when confronted with a patient suffering from a debilitating spine metastasis of a malignant tumor it has been almost always too late to offer anything more than compassionate ineffica­ cy. Surgical treatment was balanced with life expectancy and then only rarely indicated in certain specific cases.