Spinal metastases are common in the course of a neoplasm and involve multiple pathophysiological mechanisms. The venous vascularization of the spine plays an important role in the onset and development of these secondary lesions. Their progression leads to evolving risks of fracture and neurotoxicity, all of which compromise quality of life and survival. Understanding these harmful developments requires a knowledge of the bony and ligamentar structures and of the vertebral contents, including particularities of its venous drainage.