Inclusion Criteria:  Participation in PRESENT cohort Painful radiosensitive metastases from solid tumors in the cervical, thoracic or lumbar spine needing surgical stabilization Histologic proof of malignancy or radiographic/clinical characteristics indicating malignancy beyond reasonable doubt Radiographic evidence of spinal metastases Fit for (radio)surgery Age > 18 years at the time of given informed consent in the PRESENT cohort. Written informed consent  Exclusion Criteria:  SBRT cannot be delivered, e.g. in patients who cannot lie on the treatment table because of pain Surgery cannot be performed, e.g. in patients with multiple spinal metastases that cannot be bridged Previous surgery or radiotherapy to index lesion Neurological deficits (ASIA C, B or A) Partial neurological deficits (ASIA D) with rapid progression (hours to days) Non-ambulatory patients Patient in hospice or with < 3 months life expectancy Medically inoperable or patient refused surgery Radiosensitizing systemic treatment that cannot reasonably be stopped (for example immunotherapy and EGFR inhibitors)