Management of spinal metastases is a complex process which includes services ranging from neurological surgery to medical oncology to radiation oncology. Neurosurgery hospitalists increasingly play a crucial role by coordinating diagnostic and therapeutic strategies, tailoring them to each patient’s individual needs. In this article, we review each step of the management of the spine mass from diagnosis to treatment. An emphasis is placed on the diagnosis and management of metastatic spinal cord compression. Finally, we review in detail the role of the neurosurgery hospitalist in this process.