Spinal metastases are the most commonly encountered tumor of the spine, occurring in up to 40% of patients with cancer. 5% of cancer patients may have spinal metastases and this will increase as life expectancy increases. Pain from these spinal metastases is frequently debilitating, which often decreases quality of life. Targeted vertebral bone biopsies provide, in a minimally invasive fashion, a definitive diagnosis of the underlying malignant tumor, a guide for the subsequent therapy as well as a more accurate prognostic assessment.