Primary pediatric spinal column tumors are rare lesions, but they can lead to serious morbidity if left untreated. Progressive pain, deformity, and neurologic decline may result from destructive and compressive insults on neighboring structures. In addition, histologic diagnosis is paramount in determining overall survival and management options. Evolution of spinal instrumentation has allowed safe and effective application of spinal reconstruction to the developing spine. As a result, aggressive surgical decompression, deformity correction, fusion, and gross total tumor resections may improve functional and oncologic outcomes without sacrifice of spinal stability.