This article will be of great interest to uro-oncologists. Vertebral metastasis occurs in 3-5% of all cancers (most commonly in prostate, breast and lung cancer). It can cause pain, vertebral collapse and cord compression. Data from the National Institute for Health & Care Excellence (NICE) suggests there are around 4000 cases of vertebral metastasis per year in England and wales. Metastatic compression can be in the spinal cord or the cauda equine. The hallmark of diagnosis is an MRI of the whole spine: sensitivity (93%), specificity (97%). NICE recommends that MRI is carried out within 24 hours of suspicion. CT scan and bone scan are of limited value. Treatment options are discussed in detail in the article and include steroids, radiotherapy and surgery. Spinal Instability Neoplastic Score (SINS) is a validated tool to determine the clinical instability of the spine.