The number of patients with symptomatic metastases increases from year to year. Especially spinal metastases often lead to severe pain which often cannot be treated adequately by conservative treatment. Surgeons are confronted with the risk of instability, pathological fractures and neurological failure and the surgical treatment necessary in most cases is nowadays becoming an even greater challenge. The surgical procedure has changed considerably in recent years. The therapy is patient-individualized, the selection of implants and technology is adapted to the physical condition of the patient and the progression of the underlying disease. The main targets of the surgical treatment of spinal metastases have to be sufficient pain reduction with restoration of mobility as well as with the prevention of neurological deficits caused by progressive osteolysis. There are two minimally invasive stabilization procedures which can basically be applied. Under certain circumstances a single kyphoplasty/vertebroplasty procedure can be sufficient, in contrast to the possibility of short or long percutaneous posterior stabilization in combination with selective decompression of neural structures. These percutaneous surgical procedures currently have an important place in the surgical treatment of spinal metastases. The advantages are a less traumatic intervention for patients with advanced malignant diseases and poor general condition. Low intraoperative loss of blood means less intraoperative stress for the patient and minor surgical approaches lead to rapid mobilization and effective pain relief. As a result the hospital stay is shorter, adjuvant therapy can be started earlier and patients can be discharged sooner.