Tumors and tumor-like conditions of the spine, although rare, should be included in the differential diagnosis of infants and children with back pain. Skeletal pathology is more frequently the cause of back pain in children than in adults. Although most tumors and tumor-like conditions of the spine in children are benign, many require surgery. Children with malignant tumors of the spine (with the exception of leukemia and lymphoma) may require multimodality therapy, including surgery, to achieve long-term cure. Advances in imaging, surgical technique, surgical technology, and adjuvant therapy have led to improvements in diagnosis and treatment and, thus, outcomes. In many cases, however, early and accurate diagnosis is often possible based on only clinical history, physical examination, and plain radiographic imaging.