Background: Operative decompression, usually anteriorly, and stabilization are appropriate for patients with spinal metas-tases and intractable pain due to mechanical causes, spinal instability, or neurological impairment. Material and Methods: Sixty-four patients with spinal metastatic disease, treated surgically between 1972 and 1991 at the Department for Orthopedics, University Clinics Innsbruck, were reviewed. 35 cases of surgical stabilization were performed by an anterior, 21 by a posterior approach, and 8 by a combination of both. The most common primary tumors were cancers of the breast, kidney and thyroid gland. Results: Postoperatively, pain was significantly relieved in 59 patients (95%) and neurological deficits could be improved in 17 patients (39%). The median survival time of all patients with metastatic diseases was 3.5 months, of those with cancer of the thyroid gland or cancer of the breast 36.9 or 12.4 months, respectively. Survival time correlated to type of primary tumor, single or multiple involvement of bone, and presence of metastasis other than bone. One case of pulmonary thrombembolism and one case of cardiorespiratory failure due to myocardial infarction amounted to a total of two lethal perioperative events. Conclusions: Operative treatment of spinal metastases in appropriately selected patients leads to significant postoperative pain relief and restoration of impaired neurologic function. Mobility may be restored and a considerable alleviation in caring achieved. Surgery may increase the quality but not the duration of remaining life.