The past few years have witnessed remarkable advances in spinal imaging, radiosurgery, and minimally invasive procedures, such as vertebroplasty and kyphoplasty, as well as improved spinal surgical options with stabilization through instrumentation. These advances provide opportunities to treat patients with vertebral metastases and metastatic epidural spinal cord compression (MESCC) more successfully. In addition, a new study demonstrates that the time to develop motor weakness is an independent prognostic factor in outcome in patients with MESCC. These advances are reviewed.