: Age, location of the tumor, and detailed patient history can narrow the differential diagnosis of spinal bone lesions, including metastasis and primary benign and malignant bone tumors. Computed tomography and magnetic resonance imaging are both crucial in evaluating the characteristics of spinal bone tumors. Growth speed and Lodwick margin description can differentiate malignant from benign tumors to a certain degree. Positron emission tomography has a limited ability to differentiate malignant from benign tumors. A biopsy is often required for a definitive diagnosis. To select the optimal treatment for spinal metastasis, neurological status by epidural spinal cord compression grade (axial T2-weighted magnetic resonance image), radiosensitivity of tumor histology, mechanical instability by Spine Instability Neoplastic Score (sagittal and axial computed tomography image), and systemic disease should be evaluated by a multidisciplinary team. This review article summarizes the role of imaging for diagnosis and treatment of spinal bone tumors.