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The presentation of spinal tumours, especially metastases, to surgeons has increased significantly over the past few years. Recent research discussed mainly in oncology circles appears to have confirmed the important role of spinal surgery in palliative care, an area that was often dismissed as inappropriate in the past. Improvements in spinal reconstruction techniques, implants and peri-operative care have revolutionised the surgical options for patients with both primary and secondary spinal tumours. This text is, therefore, well timed in its publication. The editor has assembled a broad range of North American authors representing most healthcare professions providing care for patients with spinal tumours, including oncologists, palliative care physicians, radiotherapists, surgeons, radiologists, pain specialists and physiotherapists. This gives the book a pleasing multidisciplinary outlook, reflecting the clinical co-operation that is essential to provide proper care for such patients. The chapters are succinct and generally well referenced, giving this book appeal to a very broad range from the junior doctor embarking on an oncology or spinal surgical career to established clinicians seeking to refresh thinking on basic pathology or areas of care outside their immediate subspecialty. The basic science chapters are particularly well written – easy to cover but giving a broad understanding of, for example, the cell biology and growth of tumours. There are also useful chapters on the pathology and management of the most frequent pathological types of spinal tumour, including haematological malignancies. The surgical techniques for spinal reconstruction in tumour surgery are complex and often challenging. The book touches on these, using authors well recognised as leaders in this field but does not claim to be comprehensive in its descriptions; it is not an operative manual. However, a slightly more in-depth analysis of surgical techniques, including en-bloc spondylectomy, would have made the text more attractive to the established spinal surgeon. The section on vertebroplasty and kyphoplasty usefully reminds the spinal surgeon that injection of cement into vertebra was originally developed for oncological applications rather than osteoporotic fractures, where it is most frequently used. It can be an excellent method of pain relief in spinal tumours, with the benefits of a minimally invasive approach. The nature of a text that tries hard to give a brief overview of all the different clinical facets of cancer care means that some themes will be underdeveloped. The chapter on investigating metastasis from an unknown primary appears overly negative in the ability to help such patients surgically and, therefore, shies away from full investigation on value-for-cost basis. As the availability of radiological investigations improves and their costs concurrently decrease, clinicians are finding increasing success in coming to a working diagnosis, thereby helping the planning of palliative treatment including surgery. It would also have improved the text to see more focus and probably a complete chapter on the outcome of different combinations of intervention, which is an area of particular current research interest. Altogether, this text is a useful, well-written, referenced and edited overview of the basic tenets of spinal oncology practice. Its size and layout make it very easy to read and it can be recommended to any health professional forming part of an oncology team. It will also help to keep the improvements in spinal surgery and its outcome in the mind of all clinicians caring for patients with cancer. This, hopefully, will help to ensure that patients are not excluded from full assessment and potential treatments that are now thought significantly to improve the quality of limited life.