Cancer patients may develop spinal column and spinal cord injury symptoms related to primary spinal tumors or, more commonly, spinal metastases. Depending on location, spinal involvement may result in pain, weakness, sensory impairments, and autonomic dysfunction. Physiatrists may assist with clinical assessments of symptoms, correlating symptoms to known spinal lesions, ruling out confounding factors such as peripheral nerve and musculoskeletal injuries, distinguishing between tumor and treatment-related symptoms, improving treatment tolerance, and optimizing function. The goals of rehabilitation-led interventions for patients with neoplastic spinal involvement are similar to those with traumatic injuries: relieve symptoms, prevent further complications, assess and manage medical comorbidities, enhance functional independence, and improve quality of life.